Provider Demographics
NPI:1376755066
Name:GROSSMAN-ALWEISS, GAYLE (MD)
Entity Type:Individual
Prefix:DR
First Name:GAYLE
Middle Name:
Last Name:GROSSMAN-ALWEISS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GAYLE
Other - Middle Name:
Other - Last Name:GROSSMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:577 CHESTNUT RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WOODCLIFF LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07677-8400
Mailing Address - Country:US
Mailing Address - Phone:201-782-1700
Mailing Address - Fax:201-782-1749
Practice Address - Street 1:577 CHESTNUT RIDGE RD
Practice Address - Street 2:
Practice Address - City:WOODCLIFF LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07677-8400
Practice Address - Country:US
Practice Address - Phone:201-782-1700
Practice Address - Fax:201-782-1749
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY189971207W00000X
NJ25MA06392800207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01780872Medicaid