Provider Demographics
NPI:1497461966
Name:GRZYBOWSKI, JULIE M
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:M
Last Name:GRZYBOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 REVERE AVE
Mailing Address - Street 2:
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-3115
Mailing Address - Country:US
Mailing Address - Phone:516-348-4384
Mailing Address - Fax:
Practice Address - Street 1:1786 STATE ST
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-2973
Practice Address - Country:US
Practice Address - Phone:516-992-1350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program