Provider Demographics
NPI:1407897689
Name:GROSS, HARVEY ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:HARVEY
Middle Name:ROBERT
Last Name:GROSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 GRAND AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-4109
Mailing Address - Country:US
Mailing Address - Phone:201-567-3370
Mailing Address - Fax:201-816-1265
Practice Address - Street 1:370 GRAND AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4154
Practice Address - Country:US
Practice Address - Phone:201-567-3370
Practice Address - Fax:201-816-1265
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY25MA03205500207Q00000X
NJ25MA03205500207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
069663L4SOtherPTAN
NJ3021700Medicaid
C52924Medicare UPIN
NJ069663L4SMedicare ID - Type Unspecified