Provider Demographics
NPI:1942371778
Name:GIOVANELLI, FREDERICK ROMOLO (DC)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:ROMOLO
Last Name:GIOVANELLI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 SUSSEX DR
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3516
Mailing Address - Country:US
Mailing Address - Phone:516-627-7365
Mailing Address - Fax:718-429-6584
Practice Address - Street 1:6133 WOODHAVEN BLVD
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-2739
Practice Address - Country:US
Practice Address - Phone:718-429-6630
Practice Address - Fax:718-429-6584
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007331111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG300006816Medicare PIN
NYA300017127Medicare PIN