Provider Demographics
NPI:1053343327
Name:GROSS, JEFFREY K (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:K
Last Name:GROSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 PLAINSBORO RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:PLAINSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08536-1915
Mailing Address - Country:US
Mailing Address - Phone:609-936-0700
Mailing Address - Fax:609-936-0750
Practice Address - Street 1:5 PLAINSBORO RD
Practice Address - Street 2:SUITE 500
Practice Address - City:PLAINSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08536-1915
Practice Address - Country:US
Practice Address - Phone:609-936-0700
Practice Address - Fax:609-936-0750
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ47820207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
714739Medicare ID - Type Unspecified
D19780Medicare UPIN