Healthcare Provider Details

I. General information

NPI: 1831800531
Provider Name (Legal Business Name): CHRISTINA FELICIA GARGIULO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2022
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2079 FOREST AVE
STATEN ISLAND NY
10303-1865
US

IV. Provider business mailing address

24 MERCURY AVE
COLONIA NJ
07067-2512
US

V. Phone/Fax

Practice location:
  • Phone: 718-815-6560
  • Fax:
Mailing address:
  • Phone: 347-358-4165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number723382
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number351410
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: