Provider Demographics
NPI:1063953115
Name:BUTRICO, GINA BIANCA
Entity type:Individual
Prefix:MS
First Name:GINA
Middle Name:BIANCA
Last Name:BUTRICO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:BIANCA
Other - Last Name:DAURO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:561 ROUTE 9W
Mailing Address - Street 2:
Mailing Address - City:PIERMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10968-1116
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 CORPORATE BLVD. SOUTH
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701
Practice Address - Country:US
Practice Address - Phone:914-294-6171
Practice Address - Fax:914-294-6179
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-09
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3832192252Y00000X
252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency