Provider Demographics
NPI:1710944194
Name:SAGULLO, CYNTHIA CARROLE (MD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:CARROLE
Last Name:SAGULLO
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 1:258 GODWIN AVE
Mailing Address - Street 2:
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481
Mailing Address - Country:US
Mailing Address - Phone:201-891-3336
Mailing Address - Fax:201-891-0627
Practice Address - Street 1:19-21 FAIR LAWN AVE
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-2331
Practice Address - Country:US
Practice Address - Phone:201-254-0260
Practice Address - Fax:844-262-9607
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07103800207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
042322MACMedicare ID - Type Unspecified
H24773Medicare UPIN