Healthcare Provider Details

I. General information

NPI: 1720578255
Provider Name (Legal Business Name): MICHAEL HARGROVE MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2018
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3505 HILL BLVD STE K
YORKTOWN HEIGHTS NY
10598
US

IV. Provider business mailing address

3505 HILL BLVD STE K
YORKTOWN HEIGHTS NY
10598-1210
US

V. Phone/Fax

Practice location:
  • Phone: 914-352-6116
  • Fax: 914-352-6117
Mailing address:
  • Phone: 914-352-6116
  • Fax: 914-352-6117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DENISE DUBOSE FOULKES
Title or Position: MANAGER
Credential: LCSW-R
Phone: 914-352-6116