Provider Demographics
NPI:1821135476
Name:GULINO, LISA MICHELE (LISA GULINO)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MICHELE
Last Name:GULINO
Suffix:
Gender:F
Credentials:LISA GULINO
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:LAURIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISA GULINO
Mailing Address - Street 1:68 SOUTH SERVICE ROAD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747
Mailing Address - Country:US
Mailing Address - Phone:516-945-3000
Mailing Address - Fax:
Practice Address - Street 1:100 GREAT MEADOW RD
Practice Address - Street 2:SUITE 208
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109
Practice Address - Country:US
Practice Address - Phone:860-563-0700
Practice Address - Fax:860-563-0741
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003565367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT430001319Medicare PIN