Provider Demographics
NPI:1164650644
Name:GIAMELLI, JOSEPH L (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:L
Last Name:GIAMELLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 BRADHURST AVE.,
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NY
Mailing Address - Zip Code:10532-1533
Mailing Address - Country:US
Mailing Address - Phone:914-594-4370
Mailing Address - Fax:914-594-4513
Practice Address - Street 1:19 BRADHURST AVE
Practice Address - Street 2:STE 1400
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-2140
Practice Address - Country:US
Practice Address - Phone:914-594-4370
Practice Address - Fax:914-594-4513
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2363192080P0202X
CT0482132080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03119775Medicaid
NYA400014056Medicare PIN
NYA400014051Medicare PIN