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NPI Code Detail

MEDICARE: DR. ALAN ROSS OD PA

MEDICARE: DR. ALAN ROSS OD PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1302R00000XHealth Maintenance Organization3598NJ

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1516263OTHERNJMEDICARE PROVIDER 516263

General Provider Information

NPI Number : 1386920429
Entity Type Code : Organization
Provider Name (Legal Business Name) : DR. ALAN ROSS OD PA
Provider Business Mailing Address
First Line : 270 CLOSTER DOCK RD
Second Line :
City : CLOSTER
State : NJ
Zip : 07624-2616
Country : US
Telephone Number : 201-768-2433
Fax Number :
Provider Business Practice Location Address
First Line : 270 CLOSTER DOCK RD
Second Line :
City : CLOSTER
State : NJ
Zip : 07624-2616
Country : US
Telephone Number : 201-768-2433
Fax Number :
Authorized Official
Title or Position : OWNER/ PROVIDER
Name : DR. ALAN M ROSS
Credential : OD
Telephone Number : 201-768-2433
Provider Enumeration Date : 11/02/2011
Last Update Date : 11/02/2011

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