Provider Demographics
NPI:1356524094
Name:CHRISTOPHER D ROSS
Entity type:Organization
Organization Name:CHRISTOPHER D ROSS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:845-855-1853
Mailing Address - Street 1:198 RT 22, THE ATRIUM
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PAWLING
Mailing Address - State:NY
Mailing Address - Zip Code:12564-3242
Mailing Address - Country:US
Mailing Address - Phone:845-855-1853
Mailing Address - Fax:845-855-4687
Practice Address - Street 1:198 RT 22, THE ATRIUM
Practice Address - Street 2:SUITE 2
Practice Address - City:PAWLING
Practice Address - State:NY
Practice Address - Zip Code:12564-3242
Practice Address - Country:US
Practice Address - Phone:845-855-1853
Practice Address - Fax:845-855-4687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004130-1213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0645340002Medicare NSC
NY0645340001Medicare NSC