Provider Demographics
NPI:1861099053
Name:JULIA GROSS FAMILY HEALTH NURSE PRACTITIONER, PLLC
Entity type:Organization
Organization Name:JULIA GROSS FAMILY HEALTH NURSE PRACTITIONER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP-C
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:518-952-4000
Mailing Address - Street 1:954 ROUTE 146
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-3639
Mailing Address - Country:US
Mailing Address - Phone:518-952-4000
Mailing Address - Fax:518-280-3053
Practice Address - Street 1:954 ROUTE 146
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3639
Practice Address - Country:US
Practice Address - Phone:518-952-4000
Practice Address - Fax:518-280-3053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-01
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1114271970Medicaid