Provider Demographics
NPI:1346918729
Name:CALVACCA, GINA M
Entity Type:Individual
Prefix:MISS
First Name:GINA
Middle Name:M
Last Name:CALVACCA
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 1:600 S SERVICE RD
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-6015
Mailing Address - Country:US
Mailing Address - Phone:631-271-0777
Mailing Address - Fax:
Practice Address - Street 1:600 S SERVICE RD
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-6015
Practice Address - Country:US
Practice Address - Phone:631-271-0777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-01
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistGroup - Single Specialty
No174400000XOther Service ProvidersSpecialist