Provider Demographics
NPI:1629151246
Name:GIAMUNDO, JENNIFER (DC)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:GIAMUNDO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 OLD COUNTRY RD
Mailing Address - Street 2:SUITE 1 NE
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-4322
Mailing Address - Country:US
Mailing Address - Phone:516-741-5804
Mailing Address - Fax:516-741-5806
Practice Address - Street 1:170 OLD COUNTRY RD
Practice Address - Street 2:SUITE 1 NE
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4322
Practice Address - Country:US
Practice Address - Phone:516-741-5804
Practice Address - Fax:516-741-5806
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008597111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU99075Medicare UPIN
NYX6X54XAXQ1Medicare PIN