Provider Demographics
NPI:1376806604
Name:GROSS, GAYLE FERN (MA)
Entity Type:Individual
Prefix:MRS
First Name:GAYLE
Middle Name:FERN
Last Name:GROSS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MISS
Other - First Name:GAYLE
Other - Middle Name:FERN
Other - Last Name:KOLOTKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:41 MOHICAN RD
Mailing Address - Street 2:
Mailing Address - City:BLAIRSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07825-9689
Mailing Address - Country:US
Mailing Address - Phone:732-277-2026
Mailing Address - Fax:
Practice Address - Street 1:1049 38TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-1012
Practice Address - Country:US
Practice Address - Phone:732-277-2026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist