Healthcare Provider Details

I. General information

NPI: 1003930447
Provider Name (Legal Business Name): GARRETT PASCAVAGE CPO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 W 23RD ST SUITE 1002
NEW YORK NY
10011-2427
US

IV. Provider business mailing address

119 W 23RD ST SUITE 1002
NEW YORK NY
10011-2427
US

V. Phone/Fax

Practice location:
  • Phone: 212-243-2972
  • Fax: 212-243-5213
Mailing address:
  • Phone: 212-243-2972
  • Fax: 212-243-5213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: