MEDICARE: DR. AUSTIN J. MAROLLA OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	TUV006390-1	NY

General Provider Information

NPI Number	:	1851507891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AUSTIN J. MAROLLA OD

Provider Business Mailing Address
First Line	:	1801 ADAM CLAYTON POWELL JR BLVD APT 3B
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10026-3604
Country	:	US
Telephone Number	:	646-479-0415
Fax Number	:

Provider Business Practice Location Address
First Line	:	10219 ROOSEVELT AVE
Second Line	:
City	:	CORONA
State	:	NY
Zip	:	11368-2331
Country	:	US
Telephone Number	:	646-479-0415
Fax Number	:	718-507-2729

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	04/15/2024

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