Provider Demographics
NPI:1083777247
Name:GIACINTO KESSLER, GINA M (RD)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:M
Last Name:GIACINTO KESSLER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:M
Other - Last Name:GIACINTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:C/O NORTHEAST MEDICAL GROUP, INC.
Mailing Address - Street 2:226 MILL HILL AVE., 3RD FL
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06610-2826
Mailing Address - Country:US
Mailing Address - Phone:203-785-6060
Mailing Address - Fax:
Practice Address - Street 1:330 ORCHARD ST.
Practice Address - Street 2:SUITE 309
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511
Practice Address - Country:US
Practice Address - Phone:203-776-4677
Practice Address - Fax:203-867-5507
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2017-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ964685133V00000X
CT1066133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered