Provider Demographics
NPI:1689170623
Name:AURICCHIO, GINA MARIE (MD)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:AURICCHIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1582 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-1529
Mailing Address - Country:US
Mailing Address - Phone:718-761-0623
Mailing Address - Fax:718-761-0769
Practice Address - Street 1:1582 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-1529
Practice Address - Country:US
Practice Address - Phone:718-761-0623
Practice Address - Fax:718-761-0769
Is Sole Proprietor?:No
Enumeration Date:2018-03-30
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY311388208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program