Provider Demographics
NPI:1376960468
Name:ROSS, ANDRE (DPM)
Entity Type:Individual
Prefix:DR
First Name:ANDRE
Middle Name:
Last Name:ROSS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 E NORTHFIELD RD
Mailing Address - Street 2:SURGERY SUITE B
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-4532
Mailing Address - Country:US
Mailing Address - Phone:973-436-1407
Mailing Address - Fax:185-577-1068
Practice Address - Street 1:75 E NORTHFIELD RD
Practice Address - Street 2:SURGERY SUITE B
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-4532
Practice Address - Country:US
Practice Address - Phone:973-436-1407
Practice Address - Fax:185-577-1068
Is Sole Proprietor?:No
Enumeration Date:2014-03-26
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00325900213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery