Healthcare Provider Details

I. General information

NPI: 1861036212
Provider Name (Legal Business Name): CATHLEEN GRZECZKA LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2019
Last Update Date: 10/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4307 ALBANY POST RD
HYDE PARK NY
12538-3601
US

IV. Provider business mailing address

4307 ALBANY POST RD
HYDE PARK NY
12538-3601
US

V. Phone/Fax

Practice location:
  • Phone: 845-233-5672
  • Fax: 845-233-5327
Mailing address:
  • Phone: 845-233-5672
  • Fax: 845-233-5327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: