Provider Demographics
NPI:1972593861
Name:GROSS, DAVID IRA (AUD CCC-SLP/A FAAA)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:IRA
Last Name:GROSS
Suffix:
Gender:M
Credentials:AUD CCC-SLP/A FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 E BEECH ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-3703
Mailing Address - Country:US
Mailing Address - Phone:516-431-6017
Mailing Address - Fax:516-431-6017
Practice Address - Street 1:605 E BEECH ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-3703
Practice Address - Country:US
Practice Address - Phone:516-431-6017
Practice Address - Fax:516-431-6017
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002506231H00000X
NY001231235Z00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Not Answered237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYM15171OtherEMPIRE
NYP2738417OtherOXFORD
NYP2738417OtherOXFORD