=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023479276
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GRAZIANO D GIGLIO DDS P C
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2016
-----------------------------------------------------
Last Update Date | 11/07/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16 E 52ND ST SUITE 1200
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10022-5306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-486-6622
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16 E 52ND ST SUITE 1200
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10022-5306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-486-6622
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. GRAZIANO D. GIGLIO
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 212-486-6622
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0300X
-----------------------------------------------------
Taxonomy Name | Periodontics
-----------------------------------------------------
License Number | 042988
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223P0700X
-----------------------------------------------------
Taxonomy Name | Prosthodontics
-----------------------------------------------------
License Number | 040865
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------