Provider Demographics
NPI:1255876280
Name:GAGLIANO-PANGALLO, LORRAINE
Entity type:Individual
Prefix:MRS
First Name:LORRAINE
Middle Name:
Last Name:GAGLIANO-PANGALLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 BUCKINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-1708
Mailing Address - Country:US
Mailing Address - Phone:516-483-6958
Mailing Address - Fax:516-483-6958
Practice Address - Street 1:80 BUCKINGHAM RD
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-1708
Practice Address - Country:US
Practice Address - Phone:516-483-6958
Practice Address - Fax:516-483-6958
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist