Provider Demographics
NPI:1912720228
Name:ETIENNE, GIANNINI
Entity type:Individual
Prefix:
First Name:GIANNINI
Middle Name:
Last Name:ETIENNE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10030 DITMARS BLVD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11369-1333
Mailing Address - Country:US
Mailing Address - Phone:718-898-6471
Mailing Address - Fax:
Practice Address - Street 1:10030 DITMARS BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11369-1333
Practice Address - Country:US
Practice Address - Phone:718-898-6471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator