Provider Demographics
NPI:1396448734
Name:GOLCZEWSKI, MICHELLE MCGILL
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MCGILL
Last Name:GOLCZEWSKI
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 1:746 SLEEPY HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:BRIARCLIFF MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10510-2525
Mailing Address - Country:US
Mailing Address - Phone:914-523-0638
Mailing Address - Fax:
Practice Address - Street 1:746 SLEEPY HOLLOW RD
Practice Address - Street 2:
Practice Address - City:BRIARCLIFF MANOR
Practice Address - State:NY
Practice Address - Zip Code:10510-2525
Practice Address - Country:US
Practice Address - Phone:914-523-0638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist