Provider Demographics
NPI:1356776686
Name:PAGNOTTA, GINA ANN (LPN)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:ANN
Last Name:PAGNOTTA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:ANN
Other - Last Name:BONOMO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:15 UDELL WAY
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-3713
Mailing Address - Country:US
Mailing Address - Phone:631-434-5661
Mailing Address - Fax:631-880-4442
Practice Address - Street 1:15 UDELL WAY
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-3713
Practice Address - Country:US
Practice Address - Phone:631-434-5661
Practice Address - Fax:631-880-4442
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2328981164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse