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General NPI Number Information
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NPI Number | 1629495999
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Entity Type | Organization
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Legal Business Name | FABIO MEHRGUT, M.D.,PC
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Dates
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Enumeration Date | 03/25/2014
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Last Update Date | 03/25/2014
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Provider Practice Location Address
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Address Line | 95-11 101 AVENUE
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City | OZONE PARK
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State | NY
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Zip | 11416-2500
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Country | US
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Telephone | 718-529-4780
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Fax | 718-529-4783
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Provider Business Mailing Address
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Address Line | 95-11 101 AVENUE
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City | OZONE PARK
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State | NY
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Zip | 11416-2500
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Country | US
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Telephone | 718-529-4780
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Fax | 718-529-4783
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | DR. FABIO MEHRGUT
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Credential | M.D.
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Telephone | 718-529-4780
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | NY168071
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License Number State | NY
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