MEDICARE: DR. MARGRETH J. BRONTOLI MD

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	207W00000X	Ophthalmology Physician	180558	NY

General Provider Information

NPI Number	:	1235142639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARGRETH J. BRONTOLI MD

Provider Business Mailing Address
First Line	:	PO BOX 1000
Second Line	:
City	:	LONG BEACH
State	:	NY
Zip	:	11561-0961
Country	:	US
Telephone Number	:	516-431-1101
Fax Number	:	516-431-1890

Provider Business Practice Location Address
First Line	:	202 W PARK AVE
Second Line	:
City	:	LONG BEACH
State	:	NY
Zip	:	11561-3212
Country	:	US
Telephone Number	:	516-431-1101
Fax Number	:	516-431-1890

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

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	04/18/2008

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