# TIMOTHY D. GROTH MD PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720022015
- **Authorized official:** TIMOTHY D GROTH M.D. (PHYSICIAN)
- **Authorized official phone:** (631) 543-1440

## Contact information

- **Practice address:** 994 W JERICHO TPKE, SUITE104, SMITHTOWN, NY 11787-3235
- **Practice address phone:** (631) 543-1440
- **Practice address fax:** (631) 543-1930
- **Mailing address:** 994 W JERICHO TPKE, SUITE104, SMITHTOWN, NY 11787-3235
- **Mailing address phone:** (631) 543-1440
- **Mailing address fax:** (631) 543-1930

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | NULL | — |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | — | — |
| 208VP0000X | Pain Medicine Physician | — | NULL | — |
| 208VP0000X | Pain Medicine Physician | — | — | — |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 06/16/2006
- **Last updated:** 11/09/2020