Basic Information
| Provider Information | |||||||||
| NPI: | 1760453658 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GROSS | ||||||||
| FirstName: | FREDERIC | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1907 HIGHWAY 35 | ||||||||
| Address2: | SUITE1 | ||||||||
| City: | OAKHURST | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077552765 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7325170060 | ||||||||
| FaxNumber: | 7323801965 | ||||||||
| Practice Location | |||||||||
| Address1: | 1907 HIGHWAY 35 | ||||||||
| Address2: | SUITE1 | ||||||||
| City: | OAKHURST | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077552765 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7325170060 | ||||||||
| FaxNumber: | 7323801965 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | MA47267 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 0488607 | 01 | NJ | MEDICAID | OTHER | 443015 | 01 | NJ | CIGNA PROVIDER NUMBER | OTHER | 0101494000 | 01 | NJ | AMERIHEALTH | OTHER | 103839 | 01 | NJ | CHN PROVIDER NUMBER | OTHER | 222763 | 01 | NJ | PHCS PROVIDER # | OTHER | 69056 | 01 | NJ | GHI | OTHER | MS082 | 01 | NJ | OXFORD PROVIDER # | OTHER | OK8996 | 01 | NJ | HEALTHNET | OTHER |