Provider Demographics
NPI:1780487793
Name:NAGIB, SALLY W (DPM)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:W
Last Name:NAGIB
Suffix:
Gender:
Credentials:DPM
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:
Other - Last Name:FOAD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:11 E 14TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-3508
Mailing Address - Country:US
Mailing Address - Phone:718-559-7459
Mailing Address - Fax:
Practice Address - Street 1:11 E 14TH ST FL 2
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3508
Practice Address - Country:US
Practice Address - Phone:718-559-7459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program