Provider Demographics
NPI:1720045941
Name:GRISWOLD, JOHN J (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:GRISWOLD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 ESSJAY RD STE 170
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5782
Mailing Address - Country:US
Mailing Address - Phone:716-630-1219
Mailing Address - Fax:
Practice Address - Street 1:295 ESSJAY RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-8216
Practice Address - Country:US
Practice Address - Phone:716-630-1050
Practice Address - Fax:716-250-5925
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY178092-1208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0010069101OtherUNIVERA
NY01172650Medicaid
NY000523834003OtherHEALTH NOW
NY1907449OtherIHA
NY040426001682OtherFIDELIS
NY161000580OtherNOVA
NY178092-3BOtherWORKERS COMPENSATION
NY340010896OtherRR MEDICARE
NY161000580OtherNORTH AMERICAN PREFERRED
NY161000580OtherAETNA
NY0021748OtherGHI
NY161000580OtherEMPIRE