Healthcare Provider Details

I. General information

NPI: 1982948642
Provider Name (Legal Business Name): DANA PATRICIA GIALLORENZO M.S.E.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2012
Last Update Date: 11/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 BRAISTED AVE
STATEN ISLAND NY
10314-6172
US

IV. Provider business mailing address

113 BRAISTED AVE
STATEN ISLAND NY
10314-6172
US

V. Phone/Fax

Practice location:
  • Phone: 347-461-5607
  • Fax:
Mailing address:
  • Phone: 347-461-5607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number1413754
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: