Provider Demographics
NPI:1114257581
Name:AVELLINO, GERALYN (PT)
Entity Type:Individual
Prefix:
First Name:GERALYN
Middle Name:
Last Name:AVELLINO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:998 CARMANS RD
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-3505
Mailing Address - Country:US
Mailing Address - Phone:516-547-4730
Mailing Address - Fax:516-541-4748
Practice Address - Street 1:998 CARMANS RD
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-3505
Practice Address - Country:US
Practice Address - Phone:516-547-4730
Practice Address - Fax:516-541-4748
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-07
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012443-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY012443-1OtherLICENSE NUMBER