Provider Demographics
NPI:1750648440
Name:HASSICK, GINA M (MA, RD, LDN, NCC)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:M
Last Name:HASSICK
Suffix:
Gender:F
Credentials:MA, RD, LDN, NCC
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:M
Other - Last Name:CONSALVO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:29 JADE LN
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-7326
Mailing Address - Country:US
Mailing Address - Phone:908-892-5777
Mailing Address - Fax:484-544-8960
Practice Address - Street 1:133 N 4TH ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-3518
Practice Address - Country:US
Practice Address - Phone:908-827-1482
Practice Address - Fax:484-544-8960
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-18
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered