1750353991 NPI number — MS. GLORIA ESTHER ROSS P.T.

Table of content: MS. GLORIA ESTHER ROSS P.T. (NPI 1750353991)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750353991 NPI number — MS. GLORIA ESTHER ROSS P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSS
Provider First Name:
GLORIA
Provider Middle Name:
ESTHER
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750353991
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3803 GALLOPING HILL LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOMS RIVER
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08755-1918
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-961-1599
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3458 NEELY RD
Provider Second Line Business Practice Location Address:
305TH MEDICAL GROUP
Provider Business Practice Location Address City Name:
MCGUIRE AIR FORCE BASE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08641
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-754-9399
Provider Business Practice Location Address Fax Number:
609-754-9077
Provider Enumeration Date:
02/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  40QA00670400 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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