Healthcare Provider Details

I. General information

NPI: 1356354252
Provider Name (Legal Business Name): HAROUTYOUN MARGOSSIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 02/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7206 NARROWS AVE
BROOKLYN NY
11209-1811
US

IV. Provider business mailing address

25 HASTINGS CT
STATEN ISLAND NY
10309-3552
US

V. Phone/Fax

Practice location:
  • Phone: 718-836-9579
  • Fax: 718-836-9638
Mailing address:
  • Phone: 718-836-9579
  • Fax: 718-836-9638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number217158
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number217158-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: