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General NPI Number Information
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NPI Number | 1366965097
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Entity Type | Individual
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Provider Name | STEFANI ROSE GAGLIARDI DVM
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Gender | Female
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Dates
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Enumeration Date | 07/25/2017
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 4042 ROUTE 203
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City | NORTH CHATHAM
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State | NY
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Zip | 12184
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Country | US
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Telephone | 518-766-4600
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Fax | 518-766-4601
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Provider Business Mailing Address
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Address Line | PO BOX 54
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City | NORTH CHATHAM
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State | NY
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Zip | 12132-0054
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Country | US
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Telephone | 518-766-4600
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Fax | 518-766-4601
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 405300000X
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Taxonomy Name | Prevention Professional
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License Number | 011030-1
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License Number State | NY
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