Provider Demographics
NPI:1184633570
Name:GAGLIARDI, CAROL L (MD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:L
Last Name:GAGLIARDI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:355 GRAND STREET
Mailing Address - Street 2:4 EAST
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302
Mailing Address - Country:US
Mailing Address - Phone:201-915-2466
Mailing Address - Fax:201-915-2481
Practice Address - Street 1:377 JERSEY AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-4393
Practice Address - Country:US
Practice Address - Phone:201-309-2380
Practice Address - Fax:201-309-2381
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA48434207V00000X, 207VE0102X
TXF9459207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
010048434NJ01OtherANTHEM HEALTH INSURANCE C
223363012OtherGALAXY HEALTH NETWORK INC
223363012OtherINTERGROUP SERVICES
5351209OtherAETNA TRADITIONAL
83761OtherAMERIGROUP AMERICAID
037931500OtherAMERIHEALTH HMO
223363012OtherHEALTH PAYORS ORGANIZATIO
429019OtherCIGNA
1025384OtherHORIZON NJ HEALTH
223363012OtherHEALTH CARE PAYERS COALIT
NJ2463407Medicaid
49498OtherGHI
HUL00013200OtherAMERICHOICE
223363012OtherFAMILY CHOICE
223363012OtherGREAT WEST HEALTHCARE
223363012OtherBEECHSTREET CORPORATION M
223363012OtherCHN CONSUMER HEALTH NETWO
223363012OtherHORIZON BLUE CROSS BLUE S
E53473Medicare UPIN
NJ2463407Medicaid