Provider Demographics
NPI:1215364831
Name:JENNIFER GARGANO, M.D. PAIN MANAGEMENT PLLC
Entity Type:Organization
Organization Name:JENNIFER GARGANO, M.D. PAIN MANAGEMENT PLLC
Other - Org Name:JENNIFER GARGANO, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GARGANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-414-8348
Mailing Address - Street 1:23 LANCASTER RISE
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534
Mailing Address - Country:US
Mailing Address - Phone:585-414-8348
Mailing Address - Fax:585-381-9172
Practice Address - Street 1:23 LANCASTER RISE
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-2771
Practice Address - Country:US
Practice Address - Phone:585-414-8348
Practice Address - Fax:585-381-9172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2400711261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain