Provider Demographics
NPI:1477654580
Name:GROSS, DENNIS FREDERICK (MD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:FREDERICK
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 1:105 E 37TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-3037
Mailing Address - Country:US
Mailing Address - Phone:212-725-4555
Mailing Address - Fax:212-725-0946
Practice Address - Street 1:105 E 37TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3037
Practice Address - Country:US
Practice Address - Phone:212-725-4555
Practice Address - Fax:212-725-0946
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174233207N00000X, 207NS0135X
CT040148207N00000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207N00000XAllopathic & Osteopathic PhysiciansDermatology
Not Answered207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNS661OtherOXFORD
NY2200005OtherGHI
43F871Medicare ID - Type UnspecifiedMEDICARE
NY2200005OtherGHI