Individual
DR. GARY LANCE GROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
802 W PARK AVE, STE 213, OCEAN, NJ 07712-8526
(732) 695-2555
(732) 695-2552
Mailing address
DEPT. 453 PO BOX 1000, MEMPHIS, TN 38148-0001
(828) 575-2625
(828) 350-2174
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
25MA04805600
NJ
207K00000X
Allergy & Immunology Physician
MA048056
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
029133ZKRP
MEDICARE PTAN
NJ
01
—
029133ZVF5
MEDICARE PTAN
NJ
05
—
3408400
—
NJ
Enumeration date
06/08/2005
Last updated
10/30/2023
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