MEDICARE: NICHOLAS A SGAGLIONE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	158810	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	200008044	OTHER	NY	MEDICARE ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AS1134	OTHER		OXFORD

General Provider Information

NPI Number	:	1639126345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS A SGAGLIONE MD

Provider Business Mailing Address
First Line	:	PO BOX 5200
Second Line	:
City	:	MANHASSET
State	:	NY
Zip	:	11030-5200
Country	:	US
Telephone Number	:	516-723-2663
Fax Number	:	516-325-7190

Provider Business Practice Location Address
First Line	:	611 NORTHERN BLVD
Second Line	:	STE 200
City	:	GREAT NECK
State	:	NY
Zip	:	11021-5207
Country	:	US
Telephone Number	:	516-723-2663
Fax Number	:	516-325-7190

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	08/02/2012

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