Provider Demographics
NPI:1861597247
Name:GRZYB, STANLEY E (MD)
Entity type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:E
Last Name:GRZYB
Suffix:
Gender:M
Credentials:MD
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 1063
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05402-1063
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1840 SUGARBUSH ACCESS ROAD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:VT
Practice Address - Zip Code:05674-9747
Practice Address - Country:US
Practice Address - Phone:802-847-9005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VTA20006694207XS0117X
VT042.0006694207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
18V003OtherMVP
B85685Medicare UPIN
GRVT5337Medicare PIN