Provider Demographics
NPI:1285326066
Name:ROSS, BRANDON (MSAT, ATC)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:ROSS
Suffix:
Gender:M
Credentials:MSAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 RICHLEE CT APT 4S
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-3633
Mailing Address - Country:US
Mailing Address - Phone:516-660-4125
Mailing Address - Fax:
Practice Address - Street 1:3 HUNTINGTON QUADRANGLE # 103
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-4602
Practice Address - Country:US
Practice Address - Phone:516-660-4125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer