Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 090482 | NY |
NPI | 1023014370 |
---|---|
Provider Name | Dr. Elliott George Gross |
First Address | Purchase, NY 10577-2510 |
Second Address | Purchase, NY 10577-2510 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2005 |
Last Update Date | 19/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00143164 | (05) | NY |
C11090 | (02) | NY |