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NPI Code Detail

MEDICARE: GINA MARIE LANGIULLI RD

MEDICARE: GINA MARIE LANGIULLI RD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133N00000XNutritionist
2133V00000XRegistered Dietitian86150405NY

General Provider Information

NPI Number : 1578064937
Entity Type Code : Individual
Provider Name (Legal Business Name) : GINA MARIE LANGIULLI RD
Provider Business Mailing Address
First Line : 5 ROLLING MEADOW LN
Second Line :
City : FORT SALONGA
State : NY
Zip : 11768-2658
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 389 FORT SALONGA RD
Second Line :
City : NORTHPORT
State : NY
Zip : 11768-3089
Country : US
Telephone Number : 631-686-6658
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2018
Last Update Date : 08/04/2019

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Directions to “ GINA MARIE LANGIULLI RD” Practice Location

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