Provider Demographics
NPI:1508968629
Name:ROEMER, GINA
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:
Last Name:ROEMER
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:GINA
Other - Middle Name:
Other - Last Name:MASTRIANNI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3 SPRINGHURST DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:EAST GREENBUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12061-2261
Mailing Address - Country:US
Mailing Address - Phone:518-479-7172
Mailing Address - Fax:518-286-3798
Practice Address - Street 1:3 SPRINGHURST DR
Practice Address - Street 2:SUITE 1
Practice Address - City:EAST GREENBUSH
Practice Address - State:NY
Practice Address - Zip Code:12061-2261
Practice Address - Country:US
Practice Address - Phone:518-479-7172
Practice Address - Fax:518-286-3798
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021801225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02355044Medicaid
NYP15367Medicare UPIN
NY02355044Medicaid