Provider Demographics
NPI:1043328289
Name:GROSS, RONALD LEE (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:LEE
Last Name:GROSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3765 RIVERDALE AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1845
Mailing Address - Country:US
Mailing Address - Phone:718-601-2700
Mailing Address - Fax:718-601-6102
Practice Address - Street 1:3765 RIVERDALE AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-1845
Practice Address - Country:US
Practice Address - Phone:718-601-2700
Practice Address - Fax:718-601-6102
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2010-01-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY196995208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05926HOtherGHI MEDICARE
NY110223109OtherRAILROAD MEDICARE
NY8C858OtherEMPIRE BLUE CROSS BLUE SH
NY01634197Medicaid
NY1043328289OtherNPI
NY110223109OtherRAILROAD MEDICARE
NYG02082Medicare UPIN