1891805016 NPI number — DR. GINA M FERRANDINO PSY.D

Table of content: DR. GINA M FERRANDINO PSY.D (NPI 1891805016)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891805016 NPI number — DR. GINA M FERRANDINO PSY.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FERRANDINO
Provider First Name:
GINA
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FERRANDINO
Provider Other First Name:
GINA
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PSY.D
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1891805016
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/14/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27485 THREE MILE POINT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHAUMONT
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13622-2187
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-774-3559
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27485 THREE MILE POINT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHAUMONT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13622-2187
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-774-3559
Provider Business Practice Location Address Fax Number:
315-772-2558
Provider Enumeration Date:
08/30/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  35SI00364100 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103T00000X , with the licence number: 35SI00364100 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6941206 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".