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General NPI Number Information
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NPI Number | 1831101112
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Entity Type | Individual
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Provider Name | VERONICA A GROTH N.P.P
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Gender | Female
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Dates
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Enumeration Date | 08/13/2006
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Last Update Date | 01/05/2016
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Provider Practice Location Address
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Address Line | 4655 NESCONSET HWY
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City | PORT JEFFERSON STATION
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State | NY
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Zip | 11776-2579
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Country | US
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Telephone | 631-327-5395
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Fax | 631-642-7955
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Provider Business Mailing Address
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Address Line | 30 MARK TWAIN LN
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City | SETAUKET
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State | NY
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Zip | 11733-1764
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Country | US
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Telephone | 631-689-2410
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 400489
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License Number State | NY
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