Provider Demographics
NPI:1366478844
Name:GROSS, TIBERIU ADALBERT (MD)
Entity Type:Individual
Prefix:MR
First Name:TIBERIU
Middle Name:ADALBERT
Last Name:GROSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1749 HOOPER AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753
Mailing Address - Country:US
Mailing Address - Phone:732-279-9400
Mailing Address - Fax:732-279-9500
Practice Address - Street 1:1749 HOOPER AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753
Practice Address - Country:US
Practice Address - Phone:732-279-9400
Practice Address - Fax:732-279-9500
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA064235207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ893713Medicare ID - Type Unspecified
G37827Medicare UPIN