Healthcare Provider Details

I. General information

NPI: 1053972067
Provider Name (Legal Business Name): GIANNA MARIE GIORDANO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2019
Last Update Date: 06/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

682 FOREST AVE
STATEN ISLAND NY
10310-2507
US

IV. Provider business mailing address

118 ASPINWALL ST
STATEN ISLAND NY
10307-1627
US

V. Phone/Fax

Practice location:
  • Phone: 718-370-9412
  • Fax: 718-698-9412
Mailing address:
  • Phone: 718-702-3401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: