Provider Demographics
NPI:1285198481
Name:GARDINIER, GINA CHRISTINE
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:CHRISTINE
Last Name:GARDINIER
Suffix:
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 1:1298 STATE ROUTE 169
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13365-6024
Mailing Address - Country:US
Mailing Address - Phone:315-360-2039
Mailing Address - Fax:
Practice Address - Street 1:15 PETRIE ST
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:NY
Practice Address - Zip Code:13365-1610
Practice Address - Country:US
Practice Address - Phone:315-823-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-22
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028972-01235Z00000X
NY1259664182174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty