Provider Demographics
NPI:1508105123
Name:MARDIGRAS, GIGI G (MSED)
Entity Type:Individual
Prefix:MS
First Name:GIGI
Middle Name:G
Last Name:MARDIGRAS
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:MS
Other - First Name:GURLANDE
Other - Middle Name:
Other - Last Name:MARDIGRAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSED
Mailing Address - Street 1:1024 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-4825
Mailing Address - Country:US
Mailing Address - Phone:516-205-4506
Mailing Address - Fax:
Practice Address - Street 1:1024 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-4825
Practice Address - Country:US
Practice Address - Phone:516-205-4506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
NY$$$$$$$$$174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist