Provider Demographics
NPI:1043452964
Name:GIACOVELLI, JEANNINE K (MD)
Entity type:Individual
Prefix:DR
First Name:JEANNINE
Middle Name:K
Last Name:GIACOVELLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ELM ST STE GR-D
Mailing Address - Street 2:
Mailing Address - City:TUCKAHOE
Mailing Address - State:NY
Mailing Address - Zip Code:10707-3925
Mailing Address - Country:US
Mailing Address - Phone:914-733-6210
Mailing Address - Fax:
Practice Address - Street 1:1 ELM ST STE GR-D
Practice Address - Street 2:
Practice Address - City:TUCKAHOE
Practice Address - State:NY
Practice Address - Zip Code:10707-3925
Practice Address - Country:US
Practice Address - Phone:914-733-6210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-25
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY250226-1208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery