Doctor Name: | AGOSTINO R PUGLIESE |
NPI Number: | 1962665380 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 25MA01754200 |
Business Practice Address: | 136 Hollywood Ave Fairfield, NJ - 07004 |
Business Phone Number: | 9732279136 |
Business Fax Number: | |
Mailing Address: | 136 Hollywood Ave, FAIRFIELD |
State: | NJ |
Postal Code: | 07004 |
Phone Number: | 9732279136 |
Fax Number: | |
NPI Enumeration Date: | 07/07/2008 |
NPI Last Update Date: | 07/07/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 25MA01754200 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |