Provider Demographics
NPI:1528759404
Name:DEBRA M KROLL MD LLC
Entity type:Organization
Organization Name:DEBRA M KROLL MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:KROLL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-835-7128
Mailing Address - Street 1:1056 5TH AVE # 1B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0112
Mailing Address - Country:US
Mailing Address - Phone:617-835-7128
Mailing Address - Fax:
Practice Address - Street 1:1056 5TH AVE # 1B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0112
Practice Address - Country:US
Practice Address - Phone:212-585-4302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive SurgeryGroup - Single Specialty