Individual
GINA C PTAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1783 ROUTE 9 STE 102, HALFMOON, NY 12065-2467
(518) 383-4198
Mailing address
711 TROY SCHENECTADY RD STE 203, LATHAM, NY 12110-2461
(518) 782-3700
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
345651
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
11/14/2019
Last updated
05/09/2022
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