1326196064 NPI number — DR. MARITA GARGIULO PHD, RD, CDN

Table of content: DR. MARITA GARGIULO PHD, RD, CDN (NPI 1326196064)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326196064 NPI number — DR. MARITA GARGIULO PHD, RD, CDN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARGIULO
Provider First Name:
MARITA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD, RD, CDN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOLL
Provider Other First Name:
MARITA
Provider Other Middle Name:
GARGIULO
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1326196064
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/31/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
255 HILL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMDEN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06514-1521
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-248-8047
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH HAVEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06473-2365
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-248-8047
Provider Business Practice Location Address Fax Number:
203-248-8047
Provider Enumeration Date:
01/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  000020 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P817491 . This is a "OXFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 270000020CT01 . This is a "ANTHEM BCBS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 714375 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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