Provider Demographics
NPI:1467712075
Name:GIANNOBILE, CARLA (LAC)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:GIANNOBILE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 W 22ND ST
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-1511
Mailing Address - Country:US
Mailing Address - Phone:201-401-1094
Mailing Address - Fax:
Practice Address - Street 1:866 BROADWAY STE A
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3062
Practice Address - Country:US
Practice Address - Phone:201-436-7111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-17
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY25004779171100000X
PAAK001038171100000X
NJ25MZ00089400171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist