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General NPI Number Information
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NPI Number | 1881846962
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Entity Type | Organization
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Legal Business Name | HOLY TRINITY MEDICAL, PLLC.
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Dates
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Enumeration Date | 10/21/2008
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Last Update Date | 10/21/2008
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Provider Practice Location Address
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Address Line | 1376 CLOVE RD
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City | STATEN ISLAND
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State | NY
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Zip | 10301-4303
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Country | US
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Telephone | 718-447-1431
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Fax | 718-447-2754
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Provider Business Mailing Address
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Address Line | 1376 CLOVE RD
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City | STATEN ISLAND
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State | NY
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Zip | 10301-4303
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Country | US
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Telephone | 718-447-1431
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Fax | 718-447-2754
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NAGEH AYOOB GARAS
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Credential | M.D.
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Telephone | 718-447-1431
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 237281
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 237281
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License Number State | NY
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