Provider Demographics
NPI:1104460849
Name:GIOGLIO, NICHOLAS (LMT)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:
Last Name:GIOGLIO
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 OLIVE RD
Mailing Address - Street 2:
Mailing Address - City:MASTIC BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11951-6403
Mailing Address - Country:US
Mailing Address - Phone:631-374-9075
Mailing Address - Fax:
Practice Address - Street 1:64 MAYBROOK RD
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-3012
Practice Address - Country:US
Practice Address - Phone:631-374-9075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY954658210225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist