Healthcare Provider Details

I. General information

NPI: 1093914350
Provider Name (Legal Business Name): PEGGY ANN GARGIAN M D P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2007
Last Update Date: 05/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

458 BAY RIDGE PKWY
BROOKLYN NY
11209-2702
US

IV. Provider business mailing address

71 TODT HILL RD STE 201
STATEN ISLAND NY
10314-4534
US

V. Phone/Fax

Practice location:
  • Phone: 718-238-4157
  • Fax: 718-720-1684
Mailing address:
  • Phone: 718-720-1030
  • Fax: 718-720-1684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number151980
License Number StateNY

VIII. Authorized Official

Name: DR. PEGGY ANN GARGIAN
Title or Position: OWNER
Credential: M D P C
Phone: 718-720-1030