Provider Demographics
NPI:1801015128
Name:GERBINO-ROSEN, GINNY M (MD)
Entity type:Individual
Prefix:DR
First Name:GINNY
Middle Name:M
Last Name:GERBINO-ROSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:GINNY
Other - Middle Name:G
Other - Last Name:ROSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:118 SPORT HILL RD
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:CT
Mailing Address - Zip Code:06612-2247
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:118 SPORT HILL RD
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:CT
Practice Address - Zip Code:06612-2247
Practice Address - Country:US
Practice Address - Phone:203-372-0120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0217972084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY132872Medicaid