Healthcare Provider Details

I. General information

NPI: 1285198481
Provider Name (Legal Business Name): MRS. GINA CHRISTINE GARDINIER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2019
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 PETRIE ST
LITTLE FALLS NY
13365-1610
US

IV. Provider business mailing address

1298 STATE ROUTE 169
LITTLE FALLS NY
13365-6024
US

V. Phone/Fax

Practice location:
  • Phone: 315-823-1400
  • Fax:
Mailing address:
  • Phone: 315-360-2039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1259664182
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number028972-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: