Provider Demographics
NPI:1942209838
Name:SGROI, MICHAEL J (CPO, LPO, PT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:J
Last Name:SGROI
Suffix:
Gender:M
Credentials:CPO, LPO, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 GLENMERE RD
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-4207
Mailing Address - Country:US
Mailing Address - Phone:845-893-1149
Mailing Address - Fax:
Practice Address - Street 1:2333 MORRIS AVE STE C-210
Practice Address - Street 2:ALLCARE ORTHOTICS AND PROSTHETICS
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-5714
Practice Address - Country:US
Practice Address - Phone:908-790-9222
Practice Address - Fax:908-688-5785
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CPO02860222Z00000X, 224P00000X
NY025470-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
11457254OtherCAQH NUMBER
7595675OtherAETNA
Q108C1OtherBLUE CROSS AND BLUE SHIELD
NYMS0Q20J710Medicare ID - Type UnspecifiedMEDICARE PROVIDER #
11457254OtherCAQH NUMBER