Healthcare Provider Details

I. General information

NPI: 1336114115
Provider Name (Legal Business Name): MICHAEL DAVID HARGROVE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3130 GRAND CONCOURSE SUITE B8
BRONX NY
10458
US

IV. Provider business mailing address

17 MERLIN AVENUE
SLEEPY HOLLOW NY
10591-1606
US

V. Phone/Fax

Practice location:
  • Phone: 718-365-5662
  • Fax: 718-933-8208
Mailing address:
  • Phone: 914-490-8568
  • Fax: 718-933-8208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number188349
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: