Provider Demographics
NPI:1932446804
Name:GRZECZKA, JILLIAN MARIE
Entity Type:Individual
Prefix:MISS
First Name:JILLIAN
Middle Name:MARIE
Last Name:GRZECZKA
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 1:1911 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3913
Mailing Address - Country:US
Mailing Address - Phone:718-851-3300
Mailing Address - Fax:718-370-1597
Practice Address - Street 1:1911 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3913
Practice Address - Country:US
Practice Address - Phone:718-851-3300
Practice Address - Fax:718-370-1597
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist