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General NPI Number Information
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NPI Number | 1902233638
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Entity Type | Individual
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Provider Name | ANDREW MICHAEL GROSS M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/26/2013
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Last Update Date | 09/26/2013
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Provider Practice Location Address
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Address Line | 1353 ALTON RD
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City | ROCKVILLE CENTRE
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State | NY
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Zip | 11570-1401
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Country | US
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Telephone | 972-385-1336
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Fax | 972-385-2231
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Provider Business Mailing Address
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Address Line | 1353 ALTON RD
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City | ROCKVILLE CENTRE
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State | NY
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Zip | 11570-1401
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Country | US
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Telephone | 972-385-1336
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Fax | 972-385-2231
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 150601
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License Number State | NY
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