Provider Demographics
NPI:1245437201
Name:GERVASI, CIRINA MICHELLE (DC)
Entity type:Individual
Prefix:DR
First Name:CIRINA
Middle Name:MICHELLE
Last Name:GERVASI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2775 ISLAND CHANNEL RD
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11783-3324
Mailing Address - Country:US
Mailing Address - Phone:516-785-4289
Mailing Address - Fax:516-785-4289
Practice Address - Street 1:120 W PARK AVE
Practice Address - Street 2:SUITE 314
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-3301
Practice Address - Country:US
Practice Address - Phone:516-889-0677
Practice Address - Fax:516-889-0677
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005340111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor