Provider Demographics
NPI:1750470092
Name:GROSS, JAY N (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:N
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 1:1124 WINDSOR RD
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-2724
Mailing Address - Country:US
Mailing Address - Phone:718-920-6190
Mailing Address - Fax:718-920-8851
Practice Address - Street 1:MMC - DEPT. OF CARDIOLOGY
Practice Address - Street 2:111 EAST 210TH STREET, 3RD FL.
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467
Practice Address - Country:US
Practice Address - Phone:718-920-6190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY161057207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease