Provider Demographics
NPI:1497155428
Name:GARGALA, IWONA
Entity Type:Individual
Prefix:
First Name:IWONA
Middle Name:
Last Name:GARGALA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 SILVER LAKE RD APT 102
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-2743
Mailing Address - Country:US
Mailing Address - Phone:917-324-8718
Mailing Address - Fax:
Practice Address - Street 1:131 SILVER LAKE RD APT 102
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-2743
Practice Address - Country:US
Practice Address - Phone:917-324-8718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY23014056363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant