Healthcare Provider Details

I. General information

NPI: 1447244124
Provider Name (Legal Business Name): GIULIO BIANCHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 12/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 ROSE AVE
STATEN ISLAND NY
10306-2246
US

IV. Provider business mailing address

65 ROSE AVE
STATEN ISLAND NY
10306-2246
US

V. Phone/Fax

Practice location:
  • Phone: 718-979-9333
  • Fax:
Mailing address:
  • Phone: 718-979-9333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number199893
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: