Provider Demographics
NPI:1518429331
Name:GERGIS, MAGED SR
Entity Type:Individual
Prefix:DR
First Name:MAGED
Middle Name:
Last Name:GERGIS
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 GRANDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-1919
Mailing Address - Country:US
Mailing Address - Phone:518-512-7305
Mailing Address - Fax:
Practice Address - Street 1:505 GRANDVIEW AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-1919
Practice Address - Country:US
Practice Address - Phone:518-512-7305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-01
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0652873336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy