Provider Demographics
NPI:1568443653
Name:COFFEY, GINA MARIE (PT)
Entity type:Individual
Prefix:MRS
First Name:GINA
Middle Name:MARIE
Last Name:COFFEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:MARIE
Other - Last Name:IADANZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1931 MARION DR
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-1127
Mailing Address - Country:US
Mailing Address - Phone:516-524-5872
Mailing Address - Fax:
Practice Address - Street 1:1931 MARION DR
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-1127
Practice Address - Country:US
Practice Address - Phone:516-524-5872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQL2011Medicare UPIN