Provider Demographics
NPI:1922678317
Name:GROSS, AMANDA MARY (PA)
Entity Type:Individual
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First Name:AMANDA
Middle Name:MARY
Last Name:GROSS
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Gender:F
Credentials:PA
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Mailing Address - Street 1:809 ARLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11783-1306
Mailing Address - Country:US
Mailing Address - Phone:516-507-8462
Mailing Address - Fax:
Practice Address - Street 1:1000 N VILLAGE AVE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-1000
Practice Address - Country:US
Practice Address - Phone:516-705-2525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-28
Last Update Date:2021-08-09
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant