Provider Demographics
NPI:1841291275
Name:GARGIULO, RALPH ALBERICO (PA)
Entity type:Individual
Prefix:MR
First Name:RALPH
Middle Name:ALBERICO
Last Name:GARGIULO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 FOSTER RD
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL JUNCTION
Mailing Address - State:NY
Mailing Address - Zip Code:12533-6123
Mailing Address - Country:US
Mailing Address - Phone:845-226-4590
Mailing Address - Fax:
Practice Address - Street 1:45 FOSTER ROAD
Practice Address - Street 2:
Practice Address - City:HOPEWELL JUNCTION
Practice Address - State:NY
Practice Address - Zip Code:12533
Practice Address - Country:US
Practice Address - Phone:845-226-4590
Practice Address - Fax:845-226-2465
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000947363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01819878Medicaid
NY01819878Medicaid
Z87641Medicare PIN