Provider Demographics
NPI:1598875650
Name:GIOVANI, MICHELINE E (MD)
Entity Type:Individual
Prefix:
First Name:MICHELINE
Middle Name:E
Last Name:GIOVANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 PURCHASE STREET
Mailing Address - Street 2:
Mailing Address - City:RYE
Mailing Address - State:NY
Mailing Address - Zip Code:10580
Mailing Address - Country:US
Mailing Address - Phone:914-921-0524
Mailing Address - Fax:914-921-0547
Practice Address - Street 1:262 PURCHASE ST
Practice Address - Street 2:
Practice Address - City:RYE
Practice Address - State:NY
Practice Address - Zip Code:10580-2102
Practice Address - Country:US
Practice Address - Phone:914-921-0524
Practice Address - Fax:914-921-0547
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228207207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYD2445132Medicaid
NY5316B1Medicare PIN
NYD2445132Medicaid