Provider Demographics
NPI:1972718732
Name:GROSS, JOSEPH E III (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:E
Last Name:GROSS
Suffix:III
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 KINGS WAY E
Mailing Address - Street 2:SUITE A-3
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-2237
Mailing Address - Country:US
Mailing Address - Phone:856-589-3331
Mailing Address - Fax:856-589-3416
Practice Address - Street 1:100 KINGS WAY E
Practice Address - Street 2:SUITE A-3
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-2237
Practice Address - Country:US
Practice Address - Phone:856-589-3331
Practice Address - Fax:856-589-3416
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMP00286363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ043807Medicare ID - Type Unspecified
NJP07585Medicare UPIN