Healthcare Provider Details

I. General information

NPI: 1023707320
Provider Name (Legal Business Name): IZABELA GRZEBYK CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2023
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 LASATTA AVE APT 804
ENGLISHTOWN NJ
07726-1604
US

IV. Provider business mailing address

21 LASATTA AVE APT 804
ENGLISHTOWN NJ
07726-1604
US

V. Phone/Fax

Practice location:
  • Phone: 201-757-2746
  • Fax:
Mailing address:
  • Phone: 201-757-2746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number41YS01093000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: