Provider Demographics
NPI:1760453658
Name:GROSS, FREDERIC R (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERIC
Middle Name:R
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 1:45 MANOR DR
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746-1972
Mailing Address - Country:US
Mailing Address - Phone:732-275-7149
Mailing Address - Fax:
Practice Address - Street 1:1907 HIGHWAY 35
Practice Address - Street 2:SUITE1
Practice Address - City:OAKHURST
Practice Address - State:NJ
Practice Address - Zip Code:07755-2765
Practice Address - Country:US
Practice Address - Phone:732-517-0060
Practice Address - Fax:732-380-1965
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA47267207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ103839OtherCHN PROVIDER NUMBER
NJ443015OtherCIGNA PROVIDER NUMBER
NJ222921463OtherTAX ID#
NJ69056OtherGHI
NJ222763OtherPHCS PROVIDER #
NJ222921463OtherBLUE CROSS BLUE SHIELD ID
NJ0488607OtherMEDICAID
NJMS082OtherOXFORD PROVIDER #
NJOK8996OtherHEALTHNET
NJ0101494000OtherAMERIHEALTH
NJ100004697OtherRAILROAD MEDICARE