Provider Demographics
NPI:1922360791
Name:GROSS, JACQUELINE HELEN (MSED)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:HELEN
Last Name:GROSS
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:MISS
Other - First Name:JACQUELINE
Other - Middle Name:HELEN
Other - Last Name:GROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSED
Mailing Address - Street 1:597 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12182-2509
Mailing Address - Country:US
Mailing Address - Phone:518-233-0544
Mailing Address - Fax:518-233-0703
Practice Address - Street 1:9 125TH ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12182-1903
Practice Address - Country:US
Practice Address - Phone:518-328-0220
Practice Address - Fax:518-328-0224
Is Sole Proprietor?:No
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist