Provider Demographics
NPI:1093879843
Name:BROSS, DAVID PETER (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:PETER
Last Name:BROSS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:45 N STATION PLZ
Mailing Address - Street 2:STE. 210
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5011
Mailing Address - Country:US
Mailing Address - Phone:516-466-9714
Mailing Address - Fax:212-557-0092
Practice Address - Street 1:45 N STATION PLZ
Practice Address - Street 2:STE. 210
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5011
Practice Address - Country:US
Practice Address - Phone:516-466-9714
Practice Address - Fax:212-557-0092
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1855942084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF65046Medicare UPIN
NY97H163Medicare ID - Type Unspecified