Provider Demographics
NPI:1366472011
Name:PUGLISI, GINA GRACE (MD)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:GRACE
Last Name:PUGLISI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CENTURY DR
Mailing Address - Street 2:
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-4610
Mailing Address - Country:US
Mailing Address - Phone:973-740-0607
Mailing Address - Fax:
Practice Address - Street 1:3 CENTURY DR
Practice Address - Street 2:
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-4610
Practice Address - Country:US
Practice Address - Phone:973-740-0607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY233426207P00000X, 208M00000X
NJMA05582200208M00000X, 207P00000X
RIMD14727208M00000X
AZ53275208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02658102Medicaid
NJ4541103Medicaid
NJ4541103Medicaid
NY140SG1Medicare PIN
NJ669748Medicare PIN