Healthcare Provider Details

I. General information

NPI: 1821241852
Provider Name (Legal Business Name): ANDREA GRYNTYSZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2008
Last Update Date: 09/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 NORTH DR
NORTH MASSAPEQUA NY
11758-1441
US

IV. Provider business mailing address

108 SULLIVAN AVE
FARMINGDALE NY
11735-5018
US

V. Phone/Fax

Practice location:
  • Phone: 516-454-8158
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number015334-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: