Provider Demographics
NPI:1205230810
Name:BURGIO, GEMMA (L-CAT, ATR-BC, MPS)
Entity Type:Individual
Prefix:
First Name:GEMMA
Middle Name:
Last Name:BURGIO
Suffix:
Gender:F
Credentials:L-CAT, ATR-BC, MPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 NEWKIRK AVE APT 2R
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-7324
Mailing Address - Country:US
Mailing Address - Phone:631-827-1274
Mailing Address - Fax:
Practice Address - Street 1:1818 NEWKIRK AVE APT 2R
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-7324
Practice Address - Country:US
Practice Address - Phone:631-827-1274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-13
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001633221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist