Provider Demographics
NPI:1376541672
Name:AGLIETTI, KAREN MARIE (DPM)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:MARIE
Last Name:AGLIETTI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6412 FRESH POND RD
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-3331
Mailing Address - Country:US
Mailing Address - Phone:718-497-3000
Mailing Address - Fax:718-497-3335
Practice Address - Street 1:6412 FRESH POND RD
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-3331
Practice Address - Country:US
Practice Address - Phone:718-497-3000
Practice Address - Fax:718-497-3335
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-11
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005171213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01554136Medicaid
NY1780895888OtherNPI
NY480026853OtherMCRR
NY1780895888OtherNPI
NY01554136Medicaid
NYU55778Medicare UPIN
NY05656Medicare PIN