Healthcare Provider Details

I. General information

NPI: 1336385012
Provider Name (Legal Business Name): JUDY GRZEGOWSKI PHYSICAL THERAPIST P
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2008
Last Update Date: 12/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 FOREST AVENUE
STATEN ISLAND NY
10302
US

IV. Provider business mailing address

719 RIFLE CAMP ROAD
WEST PATERSON NJ
07424
US

V. Phone/Fax

Practice location:
  • Phone: 718-816-1325
  • Fax:
Mailing address:
  • Phone: 973-256-2552
  • Fax: 973-256-2552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number008964-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: