Provider Demographics
NPI:1235149733
Name:GIANGRECO, BERNADETTE (DPM)
Entity Type:Individual
Prefix:DR
First Name:BERNADETTE
Middle Name:
Last Name:GIANGRECO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 CREEK CROSSING BLVD
Mailing Address - Street 2:
Mailing Address - City:HAINESPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:08036-2767
Mailing Address - Country:US
Mailing Address - Phone:609-261-9660
Mailing Address - Fax:609-261-9440
Practice Address - Street 1:3651 LAKE CENTER DR
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-2364
Practice Address - Country:US
Practice Address - Phone:352-385-9156
Practice Address - Fax:352-385-9159
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004702L213ES0131X
NJ25MD00273D213ES0131X
FLPO4218213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
V00083Medicare UPIN
NJ104001Medicare PIN