Provider Demographics
NPI:1285930289
Name:GRYZIEC, ANGELA L
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:L
Last Name:GRYZIEC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 BUTLER ST
Mailing Address - Street 2:
Mailing Address - City:DUNMORE
Mailing Address - State:PA
Mailing Address - Zip Code:18512-2815
Mailing Address - Country:US
Mailing Address - Phone:570-362-3373
Mailing Address - Fax:570-344-4090
Practice Address - Street 1:601 BUTLER ST
Practice Address - Street 2:
Practice Address - City:DUNMORE
Practice Address - State:PA
Practice Address - Zip Code:18512-2815
Practice Address - Country:US
Practice Address - Phone:570-362-3373
Practice Address - Fax:570-344-4090
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist