Provider Demographics
NPI:1407855950
Name:ROSS, CHRISTOPHER D (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:D
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 1:198 ROUTE 22
Mailing Address - Street 2:
Mailing Address - City:PAWLING
Mailing Address - State:NY
Mailing Address - Zip Code:12564-2037
Mailing Address - Country:US
Mailing Address - Phone:845-855-1853
Mailing Address - Fax:845-855-4687
Practice Address - Street 1:198 ROUTE 22
Practice Address - Street 2:
Practice Address - City:PAWLING
Practice Address - State:NY
Practice Address - Zip Code:12564-3241
Practice Address - Country:US
Practice Address - Phone:845-855-1853
Practice Address - Fax:845-855-4687
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004130-1213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01080386Medicaid
NYA400022867OtherMEDICARE PTAN
NY01080386Medicaid
NYT51446Medicare UPIN