1366456600 NPI number — MS. MARYA JOSEFA DRYGALSKI MSW, CEAP

Table of content: MS. MARYA JOSEFA DRYGALSKI MSW, CEAP (NPI 1366456600)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366456600 NPI number — MS. MARYA JOSEFA DRYGALSKI MSW, CEAP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DRYGALSKI
Provider First Name:
MARYA
Provider Middle Name:
JOSEFA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, CEAP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
IGNARZAK
Provider Other First Name:
MARYA
Provider Other Middle Name:
JOSEFA
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1366456600
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/24/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
116 MARKET ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT CLEMENS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48043-5674
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-465-4444
Provider Business Mailing Address Fax Number:
586-783-2761

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24401 CAPITAL BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLINTON TOWNSHIP
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48036-1343
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-783-2940
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  6801060215 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 139863SW . This is a "CARE CHOICES HMO" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 094859000 . This is a "MAGELLAN HEALTH SERVICES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: MD060215 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0892947 . This is a "BLUE CROSS BLUE SHIELD MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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