Provider Demographics
NPI:1932208444
Name:GIACALONE, PETER MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:MICHAEL
Last Name:GIACALONE
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 1:900 MAIN STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-1604
Mailing Address - Country:US
Mailing Address - Phone:631-467-1760
Mailing Address - Fax:631-467-1785
Practice Address - Street 1:900 MAIN STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-1604
Practice Address - Country:US
Practice Address - Phone:631-467-1760
Practice Address - Fax:631-467-1785
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX000802111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01745582Medicaid
T51690Medicare UPIN
NYX03671Medicare ID - Type Unspecified