Provider Demographics
NPI:1285675256
Name:GRZYBOWSKI, JOAN M (DO)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:M
Last Name:GRZYBOWSKI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 824112
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-2547
Mailing Address - Country:US
Mailing Address - Phone:215-871-6380
Mailing Address - Fax:215-871-6381
Practice Address - Street 1:4190 CITY AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-1626
Practice Address - Country:US
Practice Address - Phone:215-871-6380
Practice Address - Fax:215-871-6381
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006483L208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1027872OtherKEYSTONE MERCY
PA0122425001OtherAMERICHOICE (UHC MA PLAN)
PA16523-OS006483LOtherHEALTH PARTNERS
PA2260420OtherAETNA HMO
PA009163GFHOtherHGSA
PA0191601000OtherIBC - PC/KHPE
PA009163OtherHIGHMARK BLUE SHIELD
PA0012242500001Medicaid
PAP00176615/DC5012OtherRRM
PA080142306/CC4910OtherRRM
PA17713-OS006483LOtherHEALTH PARTNERS
PA4837399OtherCIGNA HMO/PPO
PA0000437OtherAETNA HMO
PA0191601000OtherAMERIHEALTH/INTERCOUNTY
PA10928051OtherCAQH ID#
PA1105398OtherKEYSTONE MERCY
PA249621OtherPHCS
PA4279361OtherAETNA PPO
PAP00176615/DC5012OtherRRM