Healthcare Provider Details

I. General information

NPI: 1417930546
Provider Name (Legal Business Name): GARBIS DABAGHIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 MASON AVENUE
STATEN ISLAND NY
10305
US

IV. Provider business mailing address

1 EDGEWATER ST 6TH FLOOR STE#1
STATEN ISLAND NY
10305-4900
US

V. Phone/Fax

Practice location:
  • Phone: 718-226-1458
  • Fax: 718-226-5920
Mailing address:
  • Phone: 718-226-1047
  • Fax: 718-226-1039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number191179
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: