Active NPI
Gina Siracusano, ATC, CES
- Athletic Trainer
- Mastic Beach, NY
National Provider Identifier
1790384410
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 002663-01
- Practice address
- 630 Mastic Rd Ste 4
Mastic Beach, NY 11951-1020 - Phone
- (631) 704-1899
- NPI assigned
- Oct 23, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 002663-01 | NY | Primary |
Addresses
Primary practice location
630 Mastic Rd Ste 4
Mastic Beach, NY 11951-1020
Mailing address
PO Box 57
Moriches, NY 11955-0057
Phone (631) 704-1899
Other practice location 1
205 Beaver Dam Rd
Brookhaven, NY 11719-9707
Phone (631) 704-1899
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | GsiracusanoATC@gmail.com | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 002663-01 | NY | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1603411200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1603411200000",
"number": "1790384410",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 57",
"city": "MORICHES",
"state": "NY",
"postal_code": "119550057",
"telephone_number": "631-704-1899"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "630 MASTIC RD STE 4",
"city": "MASTIC BEACH",
"state": "NY",
"postal_code": "119511020",
"telephone_number": "631-704-1899"
}
],
"practiceLocations": [
{
"address_1": "205 Beaver Dam Rd",
"address_purpose": "LOCATION",
"city": "Brookhaven",
"state": "NY",
"postal_code": "117199707",
"country_code": "US",
"telephone_number": "631-704-1899",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SIRACUSANO",
"first_name": "GINA",
"credential": "ATC, CES",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-10-23",
"last_updated": "2020-10-23",
"certification_date": "2020-10-23",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "NY",
"license": "002663-01",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "GsiracusanoATC@gmail.com",
"affiliation": "N",
"endpointDescription": "Professional email",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "Email",
"address_1": "630 Mastic Rd Ste 4",
"city": "Mastic Beach",
"state": "NY",
"country_code": "US",
"postal_code": "119511020",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Mastic Beach, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.