Provider Demographics
NPI:1396005377
Name:GROSS, MORGAN (MS)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:GROSS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:MORGAN
Other - Middle Name:
Other - Last Name:BRADISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:706 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:NY
Mailing Address - Zip Code:13069-4905
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:706 S 4TH ST
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-4905
Practice Address - Country:US
Practice Address - Phone:315-887-5250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-23
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator