Provider Demographics
NPI:1922541556
Name:GIANNA PHYSICIAN PRACTICE OF NEW YORK, PC
Entity Type:Organization
Organization Name:GIANNA PHYSICIAN PRACTICE OF NEW YORK, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:STOLDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-745-6651
Mailing Address - Street 1:254 EASTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-1766
Mailing Address - Country:US
Mailing Address - Phone:732-745-8600
Mailing Address - Fax:
Practice Address - Street 1:15 E 40TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-0401
Practice Address - Country:US
Practice Address - Phone:212-481-1219
Practice Address - Fax:212-481-1423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty