Provider Demographics
NPI:1700122660
Name:TAMAGNINI, GREGORY (DPM)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:TAMAGNINI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 US HIGHWAY 46 STE 12
Mailing Address - Street 2:
Mailing Address - City:TOTOWA
Mailing Address - State:NJ
Mailing Address - Zip Code:07512-1833
Mailing Address - Country:US
Mailing Address - Phone:973-837-8173
Mailing Address - Fax:973-837-8174
Practice Address - Street 1:195 US HIGHWAY 46 STE 12
Practice Address - Street 2:
Practice Address - City:TOTOWA
Practice Address - State:NJ
Practice Address - Zip Code:07512-1833
Practice Address - Country:US
Practice Address - Phone:973-837-8173
Practice Address - Fax:973-837-8174
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-21
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR76240213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery