| Doctor Name: | MR. KEITH GORMAN GRUCHY |
| NPI Number: | 1255592010 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | RN |
| License Number: | 454889-1 |
| Business Practice Address: | 6301 Inducon Dr E Sanborn, NY - 141329014 |
| Business Phone Number: | 7167312030 |
| Business Fax Number: | |
| Mailing Address: | 3020 Bailey Ave, BUFFALO |
| State: | NY |
| Postal Code: | 142152814 |
| Phone Number: | 7168311800 |
| Fax Number: | |
| NPI Enumeration Date: | 06/24/2008 |
| NPI Last Update Date: | 06/24/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WA0400X |
| License Number: | 454889-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |