Healthcare Provider Details

I. General information

NPI: 1376541672
Provider Name (Legal Business Name): KAREN MARIE AGLIETTI DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 11/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6412 FRESH POND RD
RIDGEWOOD NY
11385-3331
US

IV. Provider business mailing address

6412 FRESH POND RD
RIDGEWOOD NY
11385-3331
US

V. Phone/Fax

Practice location:
  • Phone: 718-497-3000
  • Fax: 718-497-3335
Mailing address:
  • Phone: 718-497-3000
  • Fax: 718-497-3335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberN005171
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: