Provider Demographics
NPI:1871549675
Name:GROSS, MICHELLE (MA RD CDE)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:GROSS
Suffix:
Gender:F
Credentials:MA RD CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 751224
Mailing Address - Street 2:FOREST HILLS
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-8824
Mailing Address - Country:US
Mailing Address - Phone:212-426-3863
Mailing Address - Fax:
Practice Address - Street 1:1150 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1244
Practice Address - Country:US
Practice Address - Phone:212-426-3863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000010207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism