Healthcare Provider Details

I. General information

NPI: 1588602270
Provider Name (Legal Business Name): ALFRED PETER GILLIO III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 PROSPECT AVE
HACKENSACK NJ
07601-1914
US

IV. Provider business mailing address

126 E 10TH ST
NEW YORK NY
10003-7507
US

V. Phone/Fax

Practice location:
  • Phone: 201-996-5600
  • Fax: 201-996-0521
Mailing address:
  • Phone: 212-533-1068
  • Fax: 201-996-0521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number25MA06367600
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: