Provider Demographics
NPI:1659002442
Name:BIANCULLI, GINA
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:BIANCULLI
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 1:20 GILBERT AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-5312
Mailing Address - Country:US
Mailing Address - Phone:631-265-5656
Mailing Address - Fax:
Practice Address - Street 1:20 GILBERT AVE STE 202
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-5312
Practice Address - Country:US
Practice Address - Phone:631-265-5656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7130171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist