Basic Information
| Provider Information | |||||||||
| NPI: | 1376583492 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GAGLIO | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | SR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 622 W 168TH STREET | ||||||||
| Address2: | CENTER FOR LIV DISEASE AND TRANSPLANTATION PH-14 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123058941 | ||||||||
| FaxNumber: | 2123054343 | ||||||||
| Practice Location | |||||||||
| Address1: | 622 W 168TH STREET | ||||||||
| Address2: | CENTER FOR LIVER DISEASE AND TRANSPLANTATION PH-14 | ||||||||
| City: | NY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123058941 | ||||||||
| FaxNumber: | 2123054343 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2006 | ||||||||
| LastUpdateDate: | 05/08/2017 | ||||||||
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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 | 207RG0100X | 179243 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RI0008X | 1792431 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hepatology | 207RT0003X | 179243-1 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Transplant Hepatology |
ID Information
| ID | Type | State | Issuer | Description | 5512603 | 05 | NJ | MEDICAID | 179243 | 01 | NY | LICENSE | OTHER | 02143873 | 05 | NY | MEDICAID |