Provider Demographics
NPI:1275652166
Name:GUSCHEL, GINA MARIE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:MARIE
Last Name:GUSCHEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4568 SUNRISE HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11769
Mailing Address - Country:US
Mailing Address - Phone:631-472-6000
Mailing Address - Fax:631-472-9777
Practice Address - Street 1:4568 SUNRISE HIGHWAY
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:NY
Practice Address - Zip Code:11769
Practice Address - Country:US
Practice Address - Phone:631-472-6000
Practice Address - Fax:631-472-9777
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02690363A00000X
NY005451363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant