Provider Demographics
NPI:1538157029
Name:GAGLIARDI, MORRIS S (MEDICAL DOCTOR)
Entity type:Individual
Prefix:DR
First Name:MORRIS
Middle Name:S
Last Name:GAGLIARDI
Suffix:
Gender:M
Credentials:MEDICAL DOCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 MADISON ST
Mailing Address - Street 2:GOUVERNEUR OB-GYN, 2ND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-7537
Mailing Address - Country:US
Mailing Address - Phone:212-238-7244
Mailing Address - Fax:212-238-7284
Practice Address - Street 1:227 MADISON ST
Practice Address - Street 2:GOUVERNEUR OB-GYN, 2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-7537
Practice Address - Country:US
Practice Address - Phone:212-238-7244
Practice Address - Fax:212-238-7284
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06380200207V00000X
NY251966207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7054602Medicaid
NJG38060Medicare UPIN
NYA400011999Medicare PIN
NJ0894194QVKMedicare ID - Type Unspecified