Healthcare Provider Details

I. General information

NPI: 1184898306
Provider Name (Legal Business Name): GINA PUGLISI LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2008
Last Update Date: 02/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 MAIN ST
NIAGARA FALLS NY
14301-1110
US

IV. Provider business mailing address

PO BOX 373
NIAGARA FALLS NY
14302-0373
US

V. Phone/Fax

Practice location:
  • Phone: 716-940-0411
  • Fax:
Mailing address:
  • Phone: 716-940-0411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number021551-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: