Provider Demographics
NPI:1174784516
Name:SAGALLA, REX BINGUIT (DO)
Entity type:Individual
Prefix:DR
First Name:REX
Middle Name:BINGUIT
Last Name:SAGALLA
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:283 COMMUNITY DR
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-3877
Mailing Address - Country:US
Mailing Address - Phone:917-749-9342
Mailing Address - Fax:
Practice Address - Street 1:STONYBROOK UNIVESITY MEDICAL CTR
Practice Address - Street 2:HSC T 17-040
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8172
Practice Address - Country:US
Practice Address - Phone:631-444-3869
Practice Address - Fax:631-444-7502
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXP0287207R00000X
NY279854207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine