Provider Demographics
NPI:1639223480
Name:GROH, PAMELA (RD, CDE)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:
Last Name:GROH
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:
Other - Last Name:VUCICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:3 N HOWELLS POINT RD
Mailing Address - Street 2:
Mailing Address - City:BELLPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11713-2907
Mailing Address - Country:US
Mailing Address - Phone:631-240-9706
Mailing Address - Fax:
Practice Address - Street 1:1869 BRENTWOOD RD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-4625
Practice Address - Country:US
Practice Address - Phone:631-853-3426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0052361133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic