Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 056455 | NY |
N | 1223P0221X | Pediatric Dentist | 22DI02520200 | NJ |
N | 1223P0221X | Pediatric Dentist | DN19670 | FL |
NPI | 1033464607 |
---|---|
Provider Name | Dr. Agnes Barbagallo |
First Address | Wyckoff, NJ 07481-1615 |
Second Address | Wyckoff, NJ 07481-1615 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2012 |
Last Update Date | 07/11/2016 |