Provider Demographics
NPI:1720548050
Name:GAGLIA, MICHELLE T (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:T
Last Name:GAGLIA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 83RD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-3021
Mailing Address - Country:US
Mailing Address - Phone:917-848-6771
Mailing Address - Fax:
Practice Address - Street 1:RUTGERS ROBERT WOOD JOHNSON DEPARTMENT OF PEDIATRICS
Practice Address - Street 2:125 PATERSON STREET
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08903-0019
Practice Address - Country:US
Practice Address - Phone:732-235-7883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-22
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program