Provider Demographics
NPI:1871863324
Name:LISBERGER, GINA M (RN)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:M
Last Name:LISBERGER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:M
Other - Last Name:CINQUEMANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:7 SEAFIELD LN
Mailing Address - Street 2:
Mailing Address - City:WESTHAMPTON BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11978-2714
Mailing Address - Country:US
Mailing Address - Phone:631-288-1113
Mailing Address - Fax:631-730-1020
Practice Address - Street 1:3251 ROUTE 112
Practice Address - Street 2:BLDG. 9/SUITE 2
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-1446
Practice Address - Country:US
Practice Address - Phone:631-451-6007
Practice Address - Fax:631-297-8121
Is Sole Proprietor?:No
Enumeration Date:2011-12-30
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY630514163W00000X
NY630514-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse