Provider Demographics
NPI:1437128725
Name:GROSS, ELLIOT (OD)
Entity Type:Individual
Prefix:DR
First Name:ELLIOT
Middle Name:
Last Name:GROSS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1761 ROCKAWAY PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-4825
Mailing Address - Country:US
Mailing Address - Phone:718-531-1100
Mailing Address - Fax:718-444-1614
Practice Address - Street 1:1761 ROCKAWAY PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-4825
Practice Address - Country:US
Practice Address - Phone:718-531-1100
Practice Address - Fax:718-444-1614
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2949UT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00333591Medicaid
NYC95781Medicare PIN
NY00333591Medicaid