Provider Demographics
NPI:1609910736
Name:ROSS, GERALD GEORGE (SPEECH-LANGUAGE PATH)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:GEORGE
Last Name:ROSS
Suffix:
Gender:M
Credentials:SPEECH-LANGUAGE PATH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 CARY RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-1518
Mailing Address - Country:US
Mailing Address - Phone:516-466-9740
Mailing Address - Fax:516-466-9740
Practice Address - Street 1:18 CARY RD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-1518
Practice Address - Country:US
Practice Address - Phone:516-466-9740
Practice Address - Fax:516-466-9740
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013138-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist