Provider Demographics
NPI:1235142639
Name:BRONTOLI, MARGRETH J (MD)
Entity Type:Individual
Prefix:DR
First Name:MARGRETH
Middle Name:J
Last Name:BRONTOLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-0961
Mailing Address - Country:US
Mailing Address - Phone:516-431-1101
Mailing Address - Fax:516-431-1890
Practice Address - Street 1:202 W PARK AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-3212
Practice Address - Country:US
Practice Address - Phone:516-431-1101
Practice Address - Fax:516-431-1890
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY180558207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY53F061Medicare PIN
NYE44971Medicare UPIN
NY53F062Medicare PIN