Individual
RANDALL ROSS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
15 W 12TH ST, SUITE 1F, NEW YORK, NY 10011-8546
(212) 352-3354
Mailing address
19 STONEYSIDE DR, LARCHMONT, NY 10538-1417
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
170811
NY
Other
Enumeration date
01/17/2007
Last updated
07/09/2007
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