Provider Demographics
NPI:1851321368
Name:ROSS, MICHAEL J (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:ROSS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1 GUSTAVE L LEVY PL
Mailing Address - Street 2:BOX 3000
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6500
Mailing Address - Country:US
Mailing Address - Phone:212-987-3100
Mailing Address - Fax:212-731-5210
Practice Address - Street 1:5 E 98TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6501
Practice Address - Country:US
Practice Address - Phone:212-241-4060
Practice Address - Fax:212-987-0389
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2013-02-28
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Provider Licenses
StateLicense IDTaxonomies
NY209925207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02196183Medicaid
NY6X57112791Medicare Oscar/Certification
NY02196183Medicaid
NY6X57112791Medicare PIN