MEDICARE: PNINA BARGAD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	008666	NY
2	363A00000X	Physician Assistant	25MP00142900	NJ

General Provider Information

NPI Number	:	1881602233
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PNINA BARGAD

Provider Business Mailing Address
First Line	:	1065 SOUTHERN BLVD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10459-2417
Country	:	US
Telephone Number	:	718-589-2440
Fax Number	:

Provider Business Practice Location Address
First Line	:	140 E RIDGEWOOD AVE STE 390
Second Line	:
City	:	PARAMUS
State	:	NJ
Zip	:	07652-3917
Country	:	US
Telephone Number	:	201-291-6421
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	07/21/2022

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Directions to “ PNINA BARGAD ” Practice Location

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