Healthcare Provider Details

I. General information

NPI: 1811760051
Provider Name (Legal Business Name): FAUSTYNA GRZYBOWSKA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2023
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6506 MYRTLE AVE
GLENDALE NY
11385-6250
US

IV. Provider business mailing address

6506 MYRTLE AVE
GLENDALE NY
11385-6250
US

V. Phone/Fax

Practice location:
  • Phone: 929-293-4256
  • Fax: 718-367-2555
Mailing address:
  • Phone: 929-293-4256
  • Fax: 718-367-2555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number353049
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: