Provider Demographics
NPI:1518528454
Name:AHEARN, GINA
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:
Last Name:AHEARN
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 1:268 MACY RD
Mailing Address - Street 2:
Mailing Address - City:BRIARCLIFF MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10510-1027
Mailing Address - Country:US
Mailing Address - Phone:914-557-1932
Mailing Address - Fax:
Practice Address - Street 1:268 MACY RD
Practice Address - Street 2:
Practice Address - City:BRIARCLIFF MANOR
Practice Address - State:NY
Practice Address - Zip Code:10510-1027
Practice Address - Country:US
Practice Address - Phone:914-557-1932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-21
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist