Provider Demographics
NPI:1043269335
Name:GARG, PANKAJ (MD)
Entity Type:Individual
Prefix:DR
First Name:PANKAJ
Middle Name:
Last Name:GARG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 WEST AVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:BROCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14420-1322
Mailing Address - Country:US
Mailing Address - Phone:585-637-2161
Mailing Address - Fax:585-637-5819
Practice Address - Street 1:80 WEST AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:BROCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14420-1322
Practice Address - Country:US
Practice Address - Phone:585-637-2161
Practice Address - Fax:585-637-5819
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199906207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG09518Medicare UPIN
BA0364Medicare ID - Type Unspecified