Provider Demographics
NPI:1720069610
Name:PAPPAGALLO, MARCO (MD)
Entity Type:Individual
Prefix:
First Name:MARCO
Middle Name:
Last Name:PAPPAGALLO
Suffix:
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 1:5 E 128TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-1282
Mailing Address - Country:US
Mailing Address - Phone:917-692-6243
Mailing Address - Fax:646-799-9727
Practice Address - Street 1:5 E 128TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-1282
Practice Address - Country:US
Practice Address - Phone:917-692-6243
Practice Address - Fax:646-799-9727
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA095786002084N0400X, 208VP0014X, 2084P0800X
NY1804932084N0400X, 2084P0800X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01982838Medicaid
E66149Medicare UPIN
NY01982838Medicaid