MEDICARE: JENNIFER L. GIORDANO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	469046-1	NY
2	163WL0100X	Lactation Consultant (Registered Nurse)	469046-1	NY
3	363LF0000X	Family Nurse Practitioner	342175	NY

General Provider Information

NPI Number	:	1730557893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER L. GIORDANO

Provider Business Mailing Address
First Line	:	29 PENELOPE DR
Second Line	:
City	:	SETAUKET
State	:	NY
Zip	:	11733-2009
Country	:	US
Telephone Number	:	631-255-8234
Fax Number	:

Provider Business Practice Location Address
First Line	:	215 HALLOCK RD STE 3D
Second Line	:
City	:	STONY BROOK
State	:	NY
Zip	:	11790-3077
Country	:	US
Telephone Number	:	631-675-9777
Fax Number	:	631-675-9778

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2015
Last Update Date	:	03/22/2024

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