Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | 420792 | NY |
N | 207RX0202X | Medical Oncology | 420792 | NY |
Y | 363LW0102X | Nurse Practitioner - Women's Health | 420792 | NY |
NPI | 1073772794 |
---|---|
Provider Name | Dr. Randolph (randy) Eric Gross |
First Address | New York, NY 10038 |
Second Address | New York, NY 10038 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2008 |
Last Update Date | 10/09/2018 |