Provider Demographics
NPI:1053556282
Name:GIAMMARINO, THERESA (PA-C)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:GIAMMARINO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 ROUTE 34
Mailing Address - Street 2:
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-1444
Mailing Address - Country:US
Mailing Address - Phone:732-974-0404
Mailing Address - Fax:732-449-4271
Practice Address - Street 1:2315 ROUTE 34
Practice Address - Street 2:
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-1444
Practice Address - Country:US
Practice Address - Phone:732-974-0404
Practice Address - Fax:732-449-4271
Is Sole Proprietor?:No
Enumeration Date:2008-12-02
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00297600363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant