Provider Demographics
NPI:1811051592
Name:NY UROGYNECOLOGY & RECONSTRUCTIVE PELVIC SURGERY PC
Entity type:Organization
Organization Name:NY UROGYNECOLOGY & RECONSTRUCTIVE PELVIC SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAROUTYOUN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARGOSSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-836-9579
Mailing Address - Street 1:25 HASTINGS CT
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-3552
Mailing Address - Country:US
Mailing Address - Phone:718-966-8346
Mailing Address - Fax:
Practice Address - Street 1:7206 NARROWS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-1811
Practice Address - Country:US
Practice Address - Phone:718-836-9579
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY217158-1207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyUrogynecology and Reconstructive Pelvic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDE1610OtherMEDICARE RAILROAD
NY03323677Medicaid
NYW39941Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
NYH04360Medicare UPIN