Healthcare Provider Details

I. General information

NPI: 1245196062
Provider Name (Legal Business Name): LANGDONG GRADZEWICZ
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2025
Last Update Date: 12/26/2025
Certification Date: 12/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 EATON AVE
MERIDEN CT
06451-2673
US

IV. Provider business mailing address

91 EATON AVE
MERIDEN CT
06451-2673
US

V. Phone/Fax

Practice location:
  • Phone: 203-213-7498
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number134770
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: