Healthcare Provider Details

I. General information

NPI: 1306808431
Provider Name (Legal Business Name): LUZ P. GARGIULLO NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 07/21/2022
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1099 OLYMPIA RD
NORTH BELLMORE NY
11710-1938
US

IV. Provider business mailing address

1099 OLYMPIA RD
NORTH BELLMORE NY
11710-1938
US

V. Phone/Fax

Practice location:
  • Phone: 516-729-9261
  • Fax: 516-221-6881
Mailing address:
  • Phone: 516-729-9261
  • Fax: 516-221-6881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberF340044-2
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberF34-00442
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberF340044-1
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF300398-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: