Provider Demographics
NPI:1851507891
Name:MAROLLA, AUSTIN J (OD)
Entity Type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:J
Last Name:MAROLLA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:128 MARINE AVE
Mailing Address - Street 2:APT. # 3G
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-7549
Mailing Address - Country:US
Mailing Address - Phone:646-479-0415
Mailing Address - Fax:
Practice Address - Street 1:10219 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-2331
Practice Address - Country:US
Practice Address - Phone:646-479-0415
Practice Address - Fax:718-507-2729
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006390-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist