Provider Demographics
NPI:1366778607
Name:GINTY, JOAN THERESA (ANP)
Entity type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:THERESA
Last Name:GINTY
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 FERNCROFT RD
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-1805
Mailing Address - Country:US
Mailing Address - Phone:516-747-6854
Mailing Address - Fax:
Practice Address - Street 1:400 LAKEVILLE RD
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1121
Practice Address - Country:US
Practice Address - Phone:516-823-8855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-21
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF000687363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health