=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508136185
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SALVATORE M. GAGLIANO M.D.P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/12/2012
-----------------------------------------------------
Last Update Date | 01/12/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 258 PASSAIC AVE
-----------------------------------------------------
City | PASSAIC
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07055-3502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-471-8887
-----------------------------------------------------
Fax | 973-471-9162
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 258 PASSAIC AVE
-----------------------------------------------------
City | PASSAIC
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07055-3502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-471-8887
-----------------------------------------------------
Fax | 973-471-9162
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. SALVATORE MICHAEL GAGLIANO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 973-471-8887
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 25MAO3052000
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------