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NPI Code Detail

MEDICARE: DR. ELLIOT GROSS O.D.

MEDICARE:  DR. ELLIOT  GROSS  O.D.
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
1152W00000XOptometrist2949UTNY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1437128725
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ELLIOT GROSS O.D.
Provider Business Mailing Address
First Line : 1761 ROCKAWAY PKWY
Second Line :
City : BROOKLYN
State : NY
Zip : 11236-4825
Country : US
Telephone Number : 718-531-1100
Fax Number : 718-444-1614
Provider Business Practice Location Address
First Line : 1761 ROCKAWAY PKWY
Second Line :
City : BROOKLYN
State : NY
Zip : 11236-4825
Country : US
Telephone Number : 718-531-1100
Fax Number : 718-444-1614
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/17/2006
Last Update Date : 04/29/2008

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