Provider Demographics
NPI:1467018531
Name:GIARDINO, ERIN NICOLE (PA-C, ATC)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:NICOLE
Last Name:GIARDINO
Suffix:
Gender:F
Credentials:PA-C, ATC
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:SCHROEDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C, ATC
Mailing Address - Street 1:825 NORTHERN BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5323
Mailing Address - Country:US
Mailing Address - Phone:516-773-7500
Mailing Address - Fax:
Practice Address - Street 1:825 NORTHERN BLVD STE 201
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5323
Practice Address - Country:US
Practice Address - Phone:516-773-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-14
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024240363A00000X
NY670029142255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty