Provider Demographics
NPI:1427580521
Name:SAGLES, GABRIEL R (DPM)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:R
Last Name:SAGLES
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4121 42ND ST
Mailing Address - Street 2:APT 2E
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-2731
Mailing Address - Country:US
Mailing Address - Phone:917-575-7804
Mailing Address - Fax:
Practice Address - Street 1:4121 42ND ST
Practice Address - Street 2:APT 2E
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-2731
Practice Address - Country:US
Practice Address - Phone:917-575-7804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-29
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN007065213ES0103X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program