Provider Demographics
NPI:1790406841
Name:GIANATIEMPO, VICTORIA LAUREN
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LAUREN
Last Name:GIANATIEMPO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15161 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-1839
Mailing Address - Country:US
Mailing Address - Phone:718-746-5137
Mailing Address - Fax:
Practice Address - Street 1:490 DRIGGS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-2019
Practice Address - Country:US
Practice Address - Phone:718-230-1180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist