Provider Demographics
NPI:1922210038
Name:GROELLY, TONI DURINO (LAC)
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:DURINO
Last Name:GROELLY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 TURKEY HILL RD
Mailing Address - Street 2:
Mailing Address - City:BOONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07005-8920
Mailing Address - Country:US
Mailing Address - Phone:973-610-4987
Mailing Address - Fax:
Practice Address - Street 1:150 RIVER RD
Practice Address - Street 2:SUITE O-2A
Practice Address - City:MONTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07045-9441
Practice Address - Country:US
Practice Address - Phone:973-331-0035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMZ000182171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist