Provider Demographics
NPI:1811420953
Name:MAROTTA, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:MAROTTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:MERCEDES
Other - Last Name:ANEZ-GRUVER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:16 FARMVIEW DR
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-5703
Mailing Address - Country:US
Mailing Address - Phone:917-440-4947
Mailing Address - Fax:
Practice Address - Street 1:16 FARMVIEW DR
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-5703
Practice Address - Country:US
Practice Address - Phone:917-440-4947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-05
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency