Provider Demographics
NPI:1699931188
Name:GRISKAUSKAS, MARGARET DOLORES (RN)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:DOLORES
Last Name:GRISKAUSKAS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 252
Mailing Address - Street 2:
Mailing Address - City:SOUND BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11789-0252
Mailing Address - Country:US
Mailing Address - Phone:631-849-2969
Mailing Address - Fax:
Practice Address - Street 1:74 LOWER ROCKY POINT RD
Practice Address - Street 2:
Practice Address - City:SOUND BEACH
Practice Address - State:NY
Practice Address - Zip Code:11789-1356
Practice Address - Country:US
Practice Address - Phone:631-849-2969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY440054-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY440054-1Medicaid