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General NPI Number Information
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NPI Number | 1164668935
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Entity Type | Individual
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Provider Name | GINA LUCIA CORNIELLO MS.ED
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Gender | Female
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Dates
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Enumeration Date | 12/29/2008
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Last Update Date | 12/29/2008
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Provider Practice Location Address
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Address Line | 7618 69TH PL APT 1F
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City | GLENDALE
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State | NY
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Zip | 11385-7135
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Country | US
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Telephone | 917-771-7627
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Fax |
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Provider Business Mailing Address
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Address Line | 7618 69TH PL APT 1F
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City | GLENDALE
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State | NY
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Zip | 11385-7135
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 880302
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License Number State | NY
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