Provider Demographics
NPI:1861513160
Name:GRZANKOWSKI, ELAINE A (LMT)
Entity type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:A
Last Name:GRZANKOWSKI
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6810 MAIN ST
Mailing Address - Street 2:UPPER LEVEL
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5930
Mailing Address - Country:US
Mailing Address - Phone:716-632-9406
Mailing Address - Fax:716-632-9406
Practice Address - Street 1:6810 MAIN ST
Practice Address - Street 2:UPPER LEVEL
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5930
Practice Address - Country:US
Practice Address - Phone:716-632-9406
Practice Address - Fax:716-632-9406
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011833174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY011833OtherNYS LICENSE