Provider Demographics
NPI:1720415003
Name:CARUSO, GINA MARIE (LMT)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:CARUSO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 BAYLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:COPIAGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11726-5006
Mailing Address - Country:US
Mailing Address - Phone:516-510-0390
Mailing Address - Fax:
Practice Address - Street 1:320 MERRICK RD STE 3
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-3440
Practice Address - Country:US
Practice Address - Phone:631-691-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023836225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist