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General NPI Number Information
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NPI Number | 1225135197
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Entity Type | Individual
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Provider Name | HAGOP GORGISSIAN MD
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Gender | Male
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 12/07/2016
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Provider Practice Location Address
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Address Line | 11929 80TH RD
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City | KEW GARDENS
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State | NY
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Zip | 11415-1105
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Country | US
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Telephone | 917-733-3283
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Fax |
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Provider Business Mailing Address
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Address Line | 6519 247TH ST MANAGED CARE, D1-01
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City | LITTLE NECK
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State | NY
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Zip | 11362-2326
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Country | US
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Telephone | 917-733-3283
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 238973
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License Number State | NY
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