Provider Demographics
NPI:1043450281
Name:GIOVANNIELLO, DOMINICK S (DO)
Entity Type:Individual
Prefix:DR
First Name:DOMINICK
Middle Name:S
Last Name:GIOVANNIELLO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 STANWICH LN
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06013-2000
Mailing Address - Country:US
Mailing Address - Phone:917-991-7668
Mailing Address - Fax:
Practice Address - Street 1:13 STANWICH LN
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:CT
Practice Address - Zip Code:06013-2000
Practice Address - Country:US
Practice Address - Phone:917-991-7668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-28
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251653207ZP0102X
CT54309207ZB0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology