Provider Demographics
NPI:1235395104
Name:GROSS, CARLISE E (FAMILY NP)
Entity Type:Individual
Prefix:MS
First Name:CARLISE
Middle Name:E
Last Name:GROSS
Suffix:
Gender:F
Credentials:FAMILY NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX MED
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-275-4517
Mailing Address - Fax:585-442-9201
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-275-4517
Practice Address - Fax:585-442-9201
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY334124363LF0000X
NY3341241363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00838557OtherMEDICARE RAILROAD
NY02777122Medicaid
NY02777122Medicaid
NYJ400010648/BA0017Medicare PIN