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General NPI Number Information
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NPI Number | 1578064937
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Entity Type | Individual
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Provider Name | GINA MARIE LANGIULLI RD
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Gender | Female
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Dates
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Enumeration Date | 02/21/2018
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Last Update Date | 08/04/2019
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Provider Practice Location Address
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Address Line | 389 FORT SALONGA RD
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City | NORTHPORT
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State | NY
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Zip | 11768-3089
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Country | US
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Telephone | 631-686-6658
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Fax |
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Provider Business Mailing Address
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Address Line | 5 ROLLING MEADOW LN
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City | FORT SALONGA
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State | NY
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Zip | 11768-2658
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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 | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 86150405
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License Number State | NY
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