Individual
GINA CORNWALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
400 SUNRISE HWY, AMITYVILLE, NY 11701-2508
(631) 264-4000
Mailing address
337 S 12TH ST, LINDENHURST, NY 11757-4519
(631) 455-6730
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
F403129-01
NY
Other
Enumeration date
10/16/2020
Last updated
10/16/2020
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