Provider Demographics
NPI:1184478349
Name:MAGGIO, GINA (RD)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:MAGGIO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 RICHARD PL
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-3525
Mailing Address - Country:US
Mailing Address - Phone:516-724-0408
Mailing Address - Fax:
Practice Address - Street 1:54 RICHARD PL
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA PARK
Practice Address - State:NY
Practice Address - Zip Code:11762-3525
Practice Address - Country:US
Practice Address - Phone:516-724-0408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1021240133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered