Individual
MARITZA LASTRA GROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
70 N COUNTRY RD, SUITE 101, PORT JEFFERSON, NY 11777-2161
(631) 473-0037
(631) 473-0228
Mailing address
PO BOX 5540, HICKSVILLE, NY 11802-5540
(631) 473-0037
(631) 473-0228
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
159478
NY
207RP1001X
Pulmonary Disease Physician
Primary
159478
NY
207RS0012X
Sleep Medicine (Internal Medicine) Physician
159478
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01211009
—
NY
Enumeration date
12/15/2006
Last updated
02/14/2013
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