Provider Demographics
NPI:1447332614
Name:GARGIULO, NICHOLAS J III (MD FACS RPVI RVT RDM)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:J
Last Name:GARGIULO
Suffix:III
Gender:M
Credentials:MD FACS RPVI RVT RDM
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Mailing Address - Street 1:1 BROOKDALE PLAZA
Mailing Address - Street 2:PHYSICIAN ENTERPRISE
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-3139
Mailing Address - Country:US
Mailing Address - Phone:718-240-7143
Mailing Address - Fax:718-240-5808
Practice Address - Street 1:1 BROOKDALE PLAZA
Practice Address - Street 2:2ND FLOOR CHC
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-3139
Practice Address - Country:US
Practice Address - Phone:718-240-5982
Practice Address - Fax:718-240-5805
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2020-05-19
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Provider Licenses
StateLicense IDTaxonomies
VA01012601702086S0129X
NY2049052086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery