Provider Demographics
NPI:1003066879
Name:GARGIULO, LAUREN ANNE (RN)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:ANNE
Last Name:GARGIULO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3155 AMBOY RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-2799
Mailing Address - Country:US
Mailing Address - Phone:718-987-9090
Mailing Address - Fax:718-987-7488
Practice Address - Street 1:3155 AMBOY RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-2799
Practice Address - Country:US
Practice Address - Phone:718-987-9090
Practice Address - Fax:718-987-7488
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5679561163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse