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General NPI Number Information
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NPI Number | 1215109434
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Entity Type | Organization
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Legal Business Name | DR. ELAINA M GROO OD
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Dates
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Enumeration Date | 03/27/2008
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Last Update Date | 03/27/2008
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Provider Practice Location Address
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Address Line | 456 GIDNEY AVE
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City | NEWBURGH
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State | NY
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Zip | 12550-3117
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Country | US
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Telephone | 845-561-0907
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Fax | 845-565-1202
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Provider Business Mailing Address
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Address Line | 456 GIDNEY AVE
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City | NEWBURGH
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State | NY
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Zip | 12550-3117
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Country | US
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Telephone | 845-561-0907
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Fax | 845-565-1202
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Authorized Official
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Title or Position | BUSINESS OWNER
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Name | DR. ELAINA MURATORE GROO
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Credential | O.D.
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Telephone | 845-561-0907
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | TUV005487
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License Number State | NY
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