Provider Demographics
NPI:1841275914
Name:STROH, EDWARD M (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:M
Last Name:STROH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:165 N VILLAGE AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-3761
Mailing Address - Country:US
Mailing Address - Phone:516-536-9525
Mailing Address - Fax:516-536-9530
Practice Address - Street 1:165 N VILLAGE AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-3761
Practice Address - Country:US
Practice Address - Phone:516-536-9525
Practice Address - Fax:516-536-9530
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY175913207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY466819OtherAETNA
NY0400569OtherGHI
NY09880POtherHIP
NYESO97F6210OtherEMP BLUE CROSS BLUE SHIEL
NYAS718OtherOXFORD
NY01530203Medicaid
NY97F621Medicare ID - Type Unspecified
NY01530203Medicaid