Provider Demographics
NPI:1417930546
Name:DABAGHIAN, GARBIS (MD)
Entity Type:Individual
Prefix:DR
First Name:GARBIS
Middle Name:
Last Name:DABAGHIAN
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 1:1 EDGEWATER ST
Mailing Address - Street 2:6TH FLOOR STE#1
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-4900
Mailing Address - Country:US
Mailing Address - Phone:718-226-1047
Mailing Address - Fax:718-226-1039
Practice Address - Street 1:242 MASON AVENUE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305
Practice Address - Country:US
Practice Address - Phone:718-226-1458
Practice Address - Fax:718-226-5920
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY191179207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01497176Medicaid
NY002J51Medicare ID - Type Unspecified
NY02J51HW681Medicare UPIN
NY01497176Medicaid