Provider Demographics
NPI:1760038186
Name:TIDOY, GIOVANNI ACHAS
Entity Type:Individual
Prefix:
First Name:GIOVANNI
Middle Name:ACHAS
Last Name:TIDOY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2915 ASTORIA BLVD
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-1741
Mailing Address - Country:US
Mailing Address - Phone:718-626-6666
Mailing Address - Fax:212-656-1091
Practice Address - Street 1:2915 ASTORIA BLVD
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-1741
Practice Address - Country:US
Practice Address - Phone:718-626-6666
Practice Address - Fax:212-656-1091
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042298225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist