Provider Demographics
NPI:1386701654
Name:GROSS, MICHAEL L (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:L
Last Name:GROSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1 SEARS DR STE 306
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-3510
Mailing Address - Country:US
Mailing Address - Phone:201-830-2287
Mailing Address - Fax:201-830-2286
Practice Address - Street 1:1 SEARS DR STE 306
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-3510
Practice Address - Country:US
Practice Address - Phone:201-830-2287
Practice Address - Fax:201-830-2286
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA07100900207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
038348AD7QOtherMEDICARE PTAN
NJ038348CGNMedicare ID - Type Unspecified
NJ8266301Medicaid