Provider Demographics
NPI:1982665907
Name:GROSS, WILLIAM JAMES (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JAMES
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 1:225 LINCOLN PL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-3746
Mailing Address - Country:US
Mailing Address - Phone:718-638-6958
Mailing Address - Fax:
Practice Address - Street 1:591 KINGSTON AVE
Practice Address - Street 2:KINGS COUNTY HOSP.
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-1707
Practice Address - Country:US
Practice Address - Phone:718-245-4871
Practice Address - Fax:718-245-4890
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY169896-12084A0401X, 2084P0800X, 2084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00246117Medicaid
NY186BNIOtherINSURANCE PROVIDER
NYH80065Medicare UPIN