Provider Demographics
NPI:1881010221
Name:LANG, GINA M (MA)
Entity Type:Individual
Prefix:MS
First Name:GINA
Middle Name:M
Last Name:LANG
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 SUELLEN CT
Mailing Address - Street 2:
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-4107
Mailing Address - Country:US
Mailing Address - Phone:631-219-5114
Mailing Address - Fax:
Practice Address - Street 1:4 SUELLEN CT
Practice Address - Street 2:
Practice Address - City:ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11751-4107
Practice Address - Country:US
Practice Address - Phone:631-219-5114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-10
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency