Healthcare Provider Details

I. General information

NPI: 1720045941
Provider Name (Legal Business Name): JOHN J GRISWOLD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 12/13/2021
Certification Date: 12/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 ESSJAY RD
WILLIAMSVILLE NY
14221-8216
US

IV. Provider business mailing address

425 ESSJAY RD STE 170
WILLIAMSVILLE NY
14221-5782
US

V. Phone/Fax

Practice location:
  • Phone: 716-630-1050
  • Fax: 716-250-5925
Mailing address:
  • Phone: 716-630-1219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number178092-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: