Provider Demographics
NPI:1407091333
Name:GAGLIARDOTTO, SALVATORE (RPH)
Entity Type:Individual
Prefix:MR
First Name:SALVATORE
Middle Name:
Last Name:GAGLIARDOTTO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 BAYVIEW LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-3637
Mailing Address - Country:US
Mailing Address - Phone:718-227-2820
Mailing Address - Fax:
Practice Address - Street 1:1407 MADISON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6930
Practice Address - Country:US
Practice Address - Phone:212-722-3200
Practice Address - Fax:212-722-3978
Is Sole Proprietor?:No
Enumeration Date:2008-12-05
Last Update Date:2010-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047134183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist