Provider Demographics
NPI:1093914350
Name:PEGGY ANN GARGIAN M D P C
Entity Type:Organization
Organization Name:PEGGY ANN GARGIAN M D P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PEGGY ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:GARGIAN
Authorized Official - Suffix:
Authorized Official - Credentials:M D P C
Authorized Official - Phone:718-720-1030
Mailing Address - Street 1:71 TODT HILL RD
Mailing Address - Street 2:STE 201
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-4534
Mailing Address - Country:US
Mailing Address - Phone:718-720-1030
Mailing Address - Fax:718-720-1684
Practice Address - Street 1:458 BAY RIDGE PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-2702
Practice Address - Country:US
Practice Address - Phone:718-238-4157
Practice Address - Fax:718-720-1684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY151980173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYOS063OtherOXFORD
NY01069194Medicaid
NYWTW001Medicare PIN
NYB11779Medicare UPIN