Provider Demographics
NPI:1962645457
Name:GROH-SZUBA, GERALYN ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALYN
Middle Name:ANN
Last Name:GROH-SZUBA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 N VILLAGE AVE STE 409
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-1001
Mailing Address - Country:US
Mailing Address - Phone:516-277-2060
Mailing Address - Fax:516-277-2058
Practice Address - Street 1:2000 N VILLAGE AVE STE 409
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-1001
Practice Address - Country:US
Practice Address - Phone:516-277-2060
Practice Address - Fax:516-277-2058
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-13
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229603208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics