Provider Demographics
NPI:1053457234
Name:GIACOMINO DI GIORGIO MD PLLC
Entity Type:Organization
Organization Name:GIACOMINO DI GIORGIO MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GIACOMINO
Authorized Official - Middle Name:
Authorized Official - Last Name:DI GIORGIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-461-4530
Mailing Address - Street 1:4231 164TH ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-2619
Mailing Address - Country:US
Mailing Address - Phone:718-461-4530
Mailing Address - Fax:718-766-9435
Practice Address - Street 1:4231 164TH ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-2619
Practice Address - Country:US
Practice Address - Phone:718-461-4530
Practice Address - Fax:718-766-9435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193842-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG21713Medicare UPIN