Active NPI
Mitchell J Grygo, R.PH.
- Pharmacist
- Elizabeth, NJ
National Provider Identifier
1679741789
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 17113
- Practice address
- 211 Elmora Ave
Elizabeth, NJ 07202-1105 - Phone
- (908) 289-7711
- NPI assigned
- Feb 12, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 17113 | NJ | Primary |
Addresses
Primary practice location
211 Elmora Ave
Elizabeth, NJ 07202-1105
Mailing address
615 Amherst Rd
Linden, NJ 07036-5307
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 17113 | Other | NJ | NPI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17113 | NJ | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pathmark Stores Inc | Past | Accepting new patients | |
| Pathmark Stores Inc | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1202774400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1202774400000",
"number": "1679741789",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "615 AMHERST RD",
"city": "LINDEN",
"state": "NJ",
"postal_code": "070365307"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "211 ELMORA AVE",
"city": "ELIZABETH",
"state": "NJ",
"postal_code": "072021105",
"telephone_number": "908-289-7711"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRYGO",
"first_name": "MITCHELL",
"middle_name": "J",
"credential": "R.PH.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-02-12",
"last_updated": "2008-02-12",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NJ",
"license": "17113",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NPI",
"identifier": "17113",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Elizabeth, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.