Provider Demographics
NPI:1376583492
Name:GAGLIO, PAUL JOSEPH SR (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JOSEPH
Last Name:GAGLIO
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 CUMBERLAND ST PH 14
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-4705
Mailing Address - Country:US
Mailing Address - Phone:917-575-6509
Mailing Address - Fax:
Practice Address - Street 1:DOCTORS OFFICE CENTER 90 BERGEN STREET
Practice Address - Street 2:SUITE 4500
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07631
Practice Address - Country:US
Practice Address - Phone:973-972-5252
Practice Address - Fax:212-305-4343
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY179243207RG0100X
NY1792431207RI0008X
NY179243-1207RT0003X
NJ25MA05421700207RT0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RT0003XAllopathic & Osteopathic PhysiciansInternal MedicineTransplant Hepatology
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY179243OtherLICENSE
NJ5512603Medicaid
NY02143873Medicaid
NJ5512603Medicaid
NYF13808Medicare UPIN
NY16781Medicare PIN
NYF13808Medicare UPIN
NY16781Medicare PIN