Healthcare Provider Details

I. General information

NPI: 1245755925
Provider Name (Legal Business Name): ROBERT J GARIGLIO ATHLETIC TRAINER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 PITTSBURG AVE
MASSAPEQUA PARK NY
11762-1810
US

IV. Provider business mailing address

301 PITTSBURG AVE
MASSAPEQUA PARK NY
11762-1810
US

V. Phone/Fax

Practice location:
  • Phone: 516-088-4415
  • Fax:
Mailing address:
  • Phone: 516-088-4415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number000378-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: