Healthcare Provider Details

I. General information

NPI: 1114601507
Provider Name (Legal Business Name): ROSANNE GRYGA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 CREAMERY LN
BELCAMP MD
21017-1499
US

IV. Provider business mailing address

1200 CREAMERY LN
BELCAMP MD
21017-1499
US

V. Phone/Fax

Practice location:
  • Phone: 443-300-6362
  • Fax: 667-400-6110
Mailing address:
  • Phone: 443-300-6362
  • Fax: 667-400-6110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: