Provider Demographics
NPI:1699200360
Name:GAWRYLUK, GRAZYNA
Entity Type:Individual
Prefix:
First Name:GRAZYNA
Middle Name:
Last Name:GAWRYLUK
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 1:24 5TH ST
Mailing Address - Street 2:
Mailing Address - City:WOOD RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07075-2108
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 HOLLISTER RD
Practice Address - Street 2:
Practice Address - City:TETERBORO
Practice Address - State:NJ
Practice Address - Zip Code:07608-1148
Practice Address - Country:US
Practice Address - Phone:201-498-9140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06062200104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker