Provider Demographics
NPI:1225211063
Name:FRANK PETER DEGIACOMO PC
Entity type:Organization
Organization Name:FRANK PETER DEGIACOMO PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:DEGIACOMO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:718-238-5120
Mailing Address - Street 1:8114 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-3804
Mailing Address - Country:US
Mailing Address - Phone:718-238-5120
Mailing Address - Fax:718-238-5129
Practice Address - Street 1:8114 3RD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3804
Practice Address - Country:US
Practice Address - Phone:718-238-5120
Practice Address - Fax:718-238-5129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-16
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3327111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00177779OtherMEDICARE PTAN
NYU06499Medicare UPIN
NYX44901Medicare PIN