Healthcare Provider Details

I. General information

NPI: 1871560151
Provider Name (Legal Business Name): CHRISTOPHER H GANGOO PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2006
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PROSPECT AVE STE 907
HACKENSACK NJ
07601-1989
US

IV. Provider business mailing address

155 REID AVE
STATEN ISLAND NY
10305-2423
US

V. Phone/Fax

Practice location:
  • Phone: 201-342-2550
  • Fax:
Mailing address:
  • Phone: 718-226-2447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number006166-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: