Healthcare Provider Details

I. General information

NPI: 1053546242
Provider Name (Legal Business Name): HEATHER ELIZABETH GIAMBO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2009
Last Update Date: 06/11/2020
Certification Date: 06/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16TH ST AND FIRST AVE EMERGENCY MEDICINE
NEW YORK NY
10009
US

IV. Provider business mailing address

1 PERKINS SQ DEPARTMENT OF PEDIATRIC EMERGENCY MEDICINE
AKRON OH
44308-1063
US

V. Phone/Fax

Practice location:
  • Phone: 212-420-2860
  • Fax:
Mailing address:
  • Phone: 330-543-8908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number35.098742
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number278512
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: