Provider Demographics
NPI:1336697598
Name:VIRK, GURBEJ (CNIM)
Entity Type:Individual
Prefix:
First Name:GURBEJ
Middle Name:
Last Name:VIRK
Suffix:
Gender:M
Credentials:CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 ADAMS AVE
Mailing Address - Street 2:SUITE B-13
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-3618
Mailing Address - Country:US
Mailing Address - Phone:631-560-4857
Mailing Address - Fax:631-617-6023
Practice Address - Street 1:140 ADAMS AVE
Practice Address - Street 2:SUITE B-13
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-3618
Practice Address - Country:US
Practice Address - Phone:631-560-4857
Practice Address - Fax:631-617-6023
Is Sole Proprietor?:No
Enumeration Date:2016-09-16
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246ZE0500X, 2472E0500X
NY2874246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
No246ZE0500XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherEEG
No2472E0500XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherEEG