Healthcare Provider Details

I. General information

NPI: 1811051592
Provider Name (Legal Business Name): NY UROGYNECOLOGY & RECONSTRUCTIVE PELVIC SURGERY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2006
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:
Mailing address:
  • Phone: 718-966-8346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: HAROUTYOUN MARGOSSIAN
Title or Position: PRESIDENT
Credential: MD
Phone: 718-836-9579