Provider Demographics
NPI:1730792730
Name:GERACI, REGINA (NP)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:GERACI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9407 156TH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-2826
Mailing Address - Country:US
Mailing Address - Phone:718-323-3773
Mailing Address - Fax:718-323-3773
Practice Address - Street 1:9407 156TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-2826
Practice Address - Country:US
Practice Address - Phone:718-323-3773
Practice Address - Fax:718-323-3773
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF309725-01363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health