Basic Information
Provider Information
NPI: 1437707627
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PUGLIESE
FirstName: GIANLUCA
MiddleName: ALFONSO
NamePrefix:  
NameSuffix:  
Credential: DPT
OtherOrganizationName:  
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OtherCredential:  
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Mailing Information
Address1: 7 BONTECOU RD
Address2:  
City: STONY POINT
State: NY
PostalCode: 109802601
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 51-55 RTE 9W
Address2:  
City: WEST HAVERSTRAW
State: NY
PostalCode: 10993
CountryCode: US
TelephoneNumber: 8457864000
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/30/2019
LastUpdateDate: 08/30/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2251N0400X  Y Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology

No ID Information.


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