Provider Demographics
NPI:1710926175
Name:ROSS, WILLIAM M (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:M
Last Name:ROSS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 S NEW YORK RD
Mailing Address - Street 2:SUITE C4
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-9608
Mailing Address - Country:US
Mailing Address - Phone:609-748-1099
Mailing Address - Fax:609-748-1216
Practice Address - Street 1:319 E JIMMIE LEEDS RD STE 104
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-4136
Practice Address - Country:US
Practice Address - Phone:609-748-1099
Practice Address - Fax:609-748-1216
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00569700111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9130802Medicaid
NJ043453Medicare ID - Type UnspecifiedMEDICARE
U82570Medicare UPIN