Provider Demographics
NPI:1972890598
Name:MINEO-GIARDINA, MARIE M (LMT)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:M
Last Name:MINEO-GIARDINA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 SAINT JAMES PL APT 4
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14222-1424
Mailing Address - Country:US
Mailing Address - Phone:716-444-2994
Mailing Address - Fax:
Practice Address - Street 1:138 SAINT JAMES PL APT 4
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14222-1424
Practice Address - Country:US
Practice Address - Phone:716-444-2994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-04
Last Update Date:2011-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019661174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY12238005OtherBCBS PALLIDIAN HEALTH