Basic Information
| Provider Information | |||||||||
| NPI: | 1174784516 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAGALLA | ||||||||
| FirstName: | REX | ||||||||
| MiddleName: | BINGUIT | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 283 COMMUNITY DR | ||||||||
| Address2: | |||||||||
| City: | SMITHTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117873877 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9177499342 | ||||||||
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| Practice Location | |||||||||
| Address1: | STONYBROOK UNIVESITY MEDICAL CTR | ||||||||
| Address2: | HSC T 17-040 | ||||||||
| City: | STONY BROOK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117948172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314443869 | ||||||||
| FaxNumber: | 6314447502 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2008 | ||||||||
| LastUpdateDate: | 06/01/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | P0287 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 279854 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.