MEDICARE: ANDREW G HARGRAVE TECHNOLOGIST

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
1	246ZE0600X	Electroneurodiagnostic Specialist/Technologist

General Provider Information

NPI Number	:	1639029127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW G HARGRAVE TECHNOLOGIST

Provider Business Mailing Address
First Line	:	25 HAMLIN RD
Second Line	:
City	:	MAHOPAC
State	:	NY
Zip	:	10541-2729
Country	:	US
Telephone Number	:	267-334-4654
Fax Number	:

Provider Business Practice Location Address
First Line	:	9811 W CHARLESTON BLVD STE 2-641
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-7528
Country	:	US
Telephone Number	:	855-864-4322
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2026
Last Update Date	:	02/02/2026

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