Provider Demographics
NPI:1275664906
Name:ERIC L. GROSS, MD, PC
Entity Type:Organization
Organization Name:ERIC L. GROSS, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:L
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-852-7482
Mailing Address - Street 1:657 WILLOW GROVE ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-1713
Mailing Address - Country:US
Mailing Address - Phone:908-852-7482
Mailing Address - Fax:908-852-1167
Practice Address - Street 1:657 WILLOW GROVE ST
Practice Address - Street 2:SUITE 302
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-1713
Practice Address - Country:US
Practice Address - Phone:908-852-7482
Practice Address - Fax:908-852-1167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0100904415208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
100695Medicare ID - Type Unspecified