Provider Demographics
NPI:1376618983
Name:GROSS, ELISSA BETH (DO)
Entity Type:Individual
Prefix:
First Name:ELISSA
Middle Name:BETH
Last Name:GROSS
Suffix:
Gender:F
Credentials:DO
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Other - Credentials:
Mailing Address - Street 1:19 BRADHURST AVE
Mailing Address - Street 2:CHILDREN'S & WOMENS PHYSICIANS OF WESTCHESTER
Mailing Address - City:HAWTHORNE
Mailing Address - State:NY
Mailing Address - Zip Code:10532-0000
Mailing Address - Country:US
Mailing Address - Phone:914-594-3916
Mailing Address - Fax:914-594-3585
Practice Address - Street 1:19 BRADHURST AVE
Practice Address - Street 2:CHILDREN'S & WOMENS PHYSICIANS OF WESTCHESTER
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-0000
Practice Address - Country:US
Practice Address - Phone:914-594-3916
Practice Address - Fax:914-594-3585
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2012-03-23
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Provider Licenses
StateLicense IDTaxonomies
NY248423208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03068004Medicaid
NYA400008425Medicare PIN
NY03068004Medicaid