Provider Demographics
NPI:1164668935
Name:CORNIELLO, GINA LUCIA (MSED)
Entity Type:Individual
Prefix:MS
First Name:GINA
Middle Name:LUCIA
Last Name:CORNIELLO
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:MRS
Other - First Name:GINA
Other - Middle Name:LUCIA
Other - Last Name:DIBONA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSED
Mailing Address - Street 1:7618 69TH PL APT 1F
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-7135
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7618 69TH PL APT 1F
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-7135
Practice Address - Country:US
Practice Address - Phone:917-771-7627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-29
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY880302174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist