Provider Demographics
NPI:1114354339
Name:GIAMBERTONE, TRACEY (RDN)
Entity Type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:
Last Name:GIAMBERTONE
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 STEWART AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-1601
Mailing Address - Country:US
Mailing Address - Phone:516-308-9965
Mailing Address - Fax:
Practice Address - Street 1:1211 STEWART AVE STE 100
Practice Address - Street 2:
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-1601
Practice Address - Country:US
Practice Address - Phone:516-308-9965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY01097256133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered