Provider Demographics
NPI:1134218993
Name:GROSS, BETH R (MD)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:R
Last Name:GROSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:900 MERCHANTS CONCOURSE STE 216
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-5114
Mailing Address - Country:US
Mailing Address - Phone:516-226-8373
Mailing Address - Fax:844-632-8265
Practice Address - Street 1:1615 NORTHERN BLVD STE 106
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3033
Practice Address - Country:US
Practice Address - Phone:516-365-2500
Practice Address - Fax:516-365-4980
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1642652085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
4100247OtherGHI
A628399OtherOXFORD
58F021Medicare ID - Type Unspecified
4100247OtherGHI
F36244Medicare UPIN