Provider Demographics
NPI:1780611624
Name:GROEGER, WILLIAM EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:EDWARD
Last Name:GROEGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 ROCKAWAY AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-1678
Mailing Address - Country:US
Mailing Address - Phone:516-887-5502
Mailing Address - Fax:516-887-5503
Practice Address - Street 1:1800 ROCKAWAY AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:HEWLETT
Practice Address - State:NY
Practice Address - Zip Code:11557-1678
Practice Address - Country:US
Practice Address - Phone:516-887-5502
Practice Address - Fax:516-887-5503
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY117105208200000X
CA31529208200000X
PAMD021865E208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
55F191Medicare ID - Type Unspecified
A99318Medicare UPIN