Individual
AMANDA GROTTOLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1400 OLD COUNTRY RD STE C103N, WESTBURY, NY 11590-5156
(516) 990-2859
Mailing address
4 CABIN LN, EAST SETAUKET, NY 11733-3403
(631) 972-4506
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
06/14/2022
Last updated
06/14/2022
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