Provider Demographics
NPI:1447453139
Name:GROSS, JOHN BEN (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BEN
Last Name:GROSS
Suffix:
Gender:M
Credentials:PHD
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Mailing Address - Street 1:129 HICKORY GROVE DR E
Mailing Address - Street 2:
Mailing Address - City:LARCHMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10538-1707
Mailing Address - Country:US
Mailing Address - Phone:914-834-8800
Mailing Address - Fax:914-834-8800
Practice Address - Street 1:214 QUAKER RIDGE RD
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10804-2805
Practice Address - Country:US
Practice Address - Phone:914-834-8000
Practice Address - Fax:914-834-8800
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2020-05-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY008581-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01093498Medicaid
NY01093498Medicaid
NY65384Medicare ID - Type UnspecifiedGHI MEDICARE