Provider Demographics
NPI:1437356789
Name:GARGAN, JOHN FRANCIS (NP)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:FRANCIS
Last Name:GARGAN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 W 46TH ST
Mailing Address - Street 2:APT 4A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-9012
Mailing Address - Country:US
Mailing Address - Phone:917-862-1320
Mailing Address - Fax:212-740-6742
Practice Address - Street 1:2091 AMSTERDAM AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032
Practice Address - Country:US
Practice Address - Phone:212-740-6740
Practice Address - Fax:212-740-6742
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF334335363LF0000X
NY344335208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03231418Medicaid
NY334335OtherNEW YORK STATE LICENSE
NYW6L111Medicare Oscar/Certification
NY334335OtherNEW YORK STATE LICENSE