Provider Demographics
NPI:1275121220
Name:BIONDOLILLO, GINA MARIE I
Entity Type:Individual
Prefix:MISS
First Name:GINA
Middle Name:MARIE
Last Name:BIONDOLILLO
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 SANDY HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:11961-2124
Mailing Address - Country:US
Mailing Address - Phone:631-742-7256
Mailing Address - Fax:
Practice Address - Street 1:8 SANDY HOLLOW LN
Practice Address - Street 2:
Practice Address - City:RIDGE
Practice Address - State:NY
Practice Address - Zip Code:11961-2124
Practice Address - Country:US
Practice Address - Phone:631-742-7256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist