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NPI Code Detail

MEDICARE: IWONA GARGALA

MEDICARE:   IWONA  GARGALA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant23014056NY

General Provider Information

NPI Number : 1497155428
Entity Type Code : Individual
Provider Name (Legal Business Name) : IWONA GARGALA
Provider Business Mailing Address
First Line : 131 SILVER LAKE RD APT 102
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10301-2743
Country : US
Telephone Number : 917-324-8718
Fax Number :
Provider Business Practice Location Address
First Line : 131 SILVER LAKE RD APT 102
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10301-2743
Country : US
Telephone Number : 917-324-8718
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/27/2014
Last Update Date : 08/27/2014

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Directions to “ IWONA GARGALA ” Practice Location

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