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General NPI Number Information
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NPI Number | 1730682444
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Entity Type | Individual
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Provider Name | PETER SANDOR GARDOS PH.D.
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Gender | Male
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Dates
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Enumeration Date | 03/09/2018
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Last Update Date | 03/09/2018
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Provider Practice Location Address
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Address Line | 3512 QUENTIN RD STE 110
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City | BROOKLYN
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State | NY
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Zip | 11234-4245
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Country | US
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Telephone | 347-860-0149
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Fax |
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Provider Business Mailing Address
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Address Line | 1600 PERRINEVILLE RD # 2-345
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City | MONROE TOWNSHIP
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State | NJ
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Zip | 08831-4923
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Country | US
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Telephone | 732-829-5106
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 013221
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License Number State | NY
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