Provider Demographics
NPI:1821350786
Name:GINEBRA, CLAUDIO (RPA-C)
Entity Type:Individual
Prefix:
First Name:CLAUDIO
Middle Name:
Last Name:GINEBRA
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 RUSTIC AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-4448
Mailing Address - Country:US
Mailing Address - Phone:631-495-4694
Mailing Address - Fax:
Practice Address - Street 1:96 RUSTIC AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-4448
Practice Address - Country:US
Practice Address - Phone:631-495-4694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015636363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant