Provider Demographics
NPI:1306540661
Name:ROSS, KYLE GRAYSON (MA)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:GRAYSON
Last Name:ROSS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10001 ASCAN AVE
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-6811
Mailing Address - Country:US
Mailing Address - Phone:516-695-1516
Mailing Address - Fax:
Practice Address - Street 1:155 WHITE PLAINS RD STE 200
Practice Address - Street 2:
Practice Address - City:TARRYTOWN
Practice Address - State:NY
Practice Address - Zip Code:10591-5523
Practice Address - Country:US
Practice Address - Phone:914-631-4618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program