Provider Demographics
NPI:1912983230
Name:SANGINARIO, ALFRED J (DPM)
Entity Type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:J
Last Name:SANGINARIO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 BROADWAY DEPARTMENT OF MANAGED CARE 2B230.
Mailing Address - Street 2:WOODHULL MEDICAL & MENTAL HEALTH CENTER.
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206
Mailing Address - Country:US
Mailing Address - Phone:718-963-8000
Mailing Address - Fax:718-630-3122
Practice Address - Street 1:760 BROADWAY.
Practice Address - Street 2:WOODHULL. MEDICAL AND MENTAL HEALTH CENTER
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206
Practice Address - Country:US
Practice Address - Phone:718-963-8000
Practice Address - Fax:718-238-1372
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004430 1213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T90334Medicare UPIN
NYP51072Medicare ID - Type Unspecified