Provider Demographics
NPI:1225549587
Name:PRYBYLOWSKI, MARY ELIZABETH (PA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:PRYBYLOWSKI
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Gender:F
Credentials:PA
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Other - Credentials:
Mailing Address - Street 1:15 AMPERSAND AVE
Mailing Address - Street 2:
Mailing Address - City:SARANAC LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12983-1302
Mailing Address - Country:US
Mailing Address - Phone:518-441-3948
Mailing Address - Fax:
Practice Address - Street 1:66 BRINKERHOFF ST
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2919
Practice Address - Country:US
Practice Address - Phone:518-561-4430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-13
Last Update Date:2017-10-13
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant