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General NPI Number Information
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NPI Number | 1336406933
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Entity Type | Organization
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Legal Business Name | DEBRA M. KROLL, MD, LLC
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Dates
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Enumeration Date | 04/19/2012
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Last Update Date | 04/19/2012
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Provider Practice Location Address
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Address Line | 178 E 71ST ST
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City | NEW YORK
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State | NY
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Zip | 10021-5131
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Country | US
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Telephone | 212-585-4302
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Fax | 212-717-7377
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Provider Business Mailing Address
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Address Line | 178 E 71ST ST
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City | NEW YORK
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State | NY
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Zip | 10021-5131
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Country | US
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Telephone | 212-585-4302
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Fax | 212-717-7377
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Authorized Official
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Title or Position | CEO/PRESIDENT/PHYSICIAN
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Name | DR. DEBRA M. KROLL
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Credential | M.D.
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Telephone | 212-585-4302
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 237914
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License Number State | NY
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