Organization
TIMOTHY D. GROTH MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY D GROTH M.D. (PHYSICIAN)
(631) 543-1440
Entity
Organization
Contact information
Practice address
994 W JERICHO TPKE, SUITE104, SMITHTOWN, NY 11787-3235
(631) 543-1440
(631) 543-1930
Mailing address
994 W JERICHO TPKE, SUITE104, SMITHTOWN, NY 11787-3235
(631) 543-1440
(631) 543-1930
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
208VP0000X
Pain Medicine Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01491318
—
NY
Enumeration date
06/16/2006
Last updated
11/09/2020
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