Provider Demographics
NPI:1639289259
Name:GROSS, HENRY S (DPM)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:S
Last Name:GROSS
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 1:80 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-4104
Mailing Address - Country:US
Mailing Address - Phone:203-438-2316
Mailing Address - Fax:203-431-6270
Practice Address - Street 1:80 GROVE ST
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-4104
Practice Address - Country:US
Practice Address - Phone:203-438-2316
Practice Address - Fax:203-431-6270
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT404213E00000X, 213EP1101X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
030000404CT03OtherBLUE CROSS CT
2701423OtherEVERCARE CT
CT004067898Medicaid
P17063OtherOXFORD CT
012737002OtherCIGNA CT
030000404CT01OtherBLUECROSS CT
012737002OtherCIGNA CT
CT480000301Medicare ID - Type Unspecified