Healthcare Provider Details

I. General information

NPI: 1649629932
Provider Name (Legal Business Name): BRANDON GIGLIO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2016
Last Update Date: 08/12/2021
Certification Date: 08/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 55TH ST RM LB1110
BROOKLYN NY
11220-2508
US

IV. Provider business mailing address

150 55TH ST RM LB1110
BROOKLYN NY
11220-2508
US

V. Phone/Fax

Practice location:
  • Phone: 718-630-8600
  • Fax: 718-630-6329
Mailing address:
  • Phone: 718-630-8600
  • Fax: 718-630-6329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number304366
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: