Healthcare Provider Details

I. General information

NPI: 1700010469
Provider Name (Legal Business Name): REGO PARK MEDICAL CARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

6135 WOODHAVEN BLVD
REGO PARK NY
11374-2739
US

IV. Provider business mailing address

6135 WOODHAVEN BLVD
REGO PARK NY
11374-2739
US

V. Phone/Fax

Practice location:
  • Phone: 718-429-6630
  • Fax: 718-429-6584
Mailing address:
  • Phone: 718-429-6630
  • Fax: 718-429-6584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number153423-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number153643-2
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number126766-2
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number025361-1
License Number StateNY

VIII. Authorized Official

Name: DR. RICHARD P GIOVANELLI
Title or Position: OWNER
Credential: M.D.
Phone: 718-429-6630