Provider Demographics
NPI:1558458109
Name:DAGOSTINO, JOSEPH ANTHONY JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ANTHONY
Last Name:DAGOSTINO
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:100 PARK STREET
Mailing Address - Street 2:GLENS FALLS HOSPITAL - CREDENTIALING
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-4413
Mailing Address - Country:US
Mailing Address - Phone:518-926-5924
Mailing Address - Fax:518-926-6983
Practice Address - Street 1:14 HUDSON AVE
Practice Address - Street 2:SURGICAL SPECIALISTS OF GLENS FALLS HOSPITAL
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801
Practice Address - Country:US
Practice Address - Phone:518-926-5600
Practice Address - Fax:518-926-5605
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2022-03-18
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Provider Licenses
StateLicense IDTaxonomies
NY222751208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
H21201Medicare UPIN