Provider Demographics
NPI:1801379086
Name:GAGLIARDO, MARIANO GIUSEPPE
Entity Type:Individual
Prefix:MR
First Name:MARIANO
Middle Name:GIUSEPPE
Last Name:GAGLIARDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6237 79TH ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-1318
Mailing Address - Country:US
Mailing Address - Phone:718-803-2336
Mailing Address - Fax:
Practice Address - Street 1:7130 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-7260
Practice Address - Country:US
Practice Address - Phone:718-456-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY064640183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist