Individual
ALYSSA GRUDZINSKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
34 BALSAM DR, MEDFORD, NY 11763-4304
(631) 626-5859
Mailing address
34 BALSAM DR, MEDFORD, NY 11763-4304
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
310389
NY
Other
Enumeration date
01/09/2015
Last updated
01/09/2015
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