Individual
TIMOTHY D GROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
994 W JERICHO TPKE, SUITE 104, SMITHTOWN, NY 11787-3235
(631) 543-1440
(631) 543-1930
Mailing address
994 W JERICHO TPKE, SUITE 104, SMITHTOWN, NY 11787-3235
(631) 543-1440
(631) 543-1930
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
158610
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01491318
—
NY
Enumeration date
06/26/2006
Last updated
06/27/2024
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