Provider Demographics
NPI:1033357108
Name:ROY C. GRZESIAK, PH.D., PC
Entity type:Organization
Organization Name:ROY C. GRZESIAK, PH.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:C
Authorized Official - Last Name:GRZESIAK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:908-322-1313
Mailing Address - Street 1:567 PARK AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:SCOTCH PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07076-1754
Mailing Address - Country:US
Mailing Address - Phone:908-322-1313
Mailing Address - Fax:908-322-1414
Practice Address - Street 1:567 PARK AVE STE 203
Practice Address - Street 2:
Practice Address - City:SCOTCH PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07076-1754
Practice Address - Country:US
Practice Address - Phone:908-322-1313
Practice Address - Fax:908-322-1414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-28
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSI100174900103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty