Provider Demographics
NPI:1134316656
Name:SINKIEWICZ, GRACE ANN (LPN)
Entity Type:Individual
Prefix:MS
First Name:GRACE
Middle Name:ANN
Last Name:SINKIEWICZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 YAPHANK AVE
Mailing Address - Street 2:
Mailing Address - City:YAPHANK
Mailing Address - State:NY
Mailing Address - Zip Code:11980-9705
Mailing Address - Country:US
Mailing Address - Phone:631-803-0702
Mailing Address - Fax:
Practice Address - Street 1:74 YAPHANK AVE
Practice Address - Street 2:
Practice Address - City:YAPHANK
Practice Address - State:NY
Practice Address - Zip Code:11980-9705
Practice Address - Country:US
Practice Address - Phone:631-803-0702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY270108-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0002510603Medicaid