Provider Demographics
NPI:1023014370
Name:GROSS, ELLIOTT GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLIOTT
Middle Name:GEORGE
Last Name:GROSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 WESTCHESTER AVE
Mailing Address - Street 2:STE 104
Mailing Address - City:PURCHASE
Mailing Address - State:NY
Mailing Address - Zip Code:10577-2510
Mailing Address - Country:US
Mailing Address - Phone:914-251-1010
Mailing Address - Fax:914-251-0212
Practice Address - Street 1:3020 WESTCHESTER AVE
Practice Address - Street 2:STE 104
Practice Address - City:PURCHASE
Practice Address - State:NY
Practice Address - Zip Code:10577-2510
Practice Address - Country:US
Practice Address - Phone:914-251-1010
Practice Address - Fax:914-251-0212
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0904822084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00143164Medicaid
NY538361Medicare ID - Type Unspecified
NY538361Medicare PIN
NYC11090Medicare UPIN