Provider Demographics
NPI:1992874481
Name:PUGLIESE, GINA MARIE (PT)
Entity type:Individual
Prefix:MRS
First Name:GINA
Middle Name:MARIE
Last Name:PUGLIESE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 EDWARD TER
Mailing Address - Street 2:
Mailing Address - City:W HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-2810
Mailing Address - Country:US
Mailing Address - Phone:718-680-4066
Mailing Address - Fax:718-232-5048
Practice Address - Street 1:627 EDWARD TER
Practice Address - Street 2:
Practice Address - City:W HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-2810
Practice Address - Country:US
Practice Address - Phone:718-680-4066
Practice Address - Fax:718-232-5048
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027786-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ29G51Medicare ID - Type Unspecified