Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 25MA11248400 | NJ |
N | 2086S0120X | Pediatric Surgery | 60942 | WI |
NPI | 1083851737 |
---|---|
Provider Name | Dr. Erica Rachel Gross |
First Address | Stony Brook, NY 11790-0989 |
Second Address | Stony Brook, NY 11794-4874 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2009 |
Last Update Date | 03/11/2021 |