Provider Demographics
NPI:1912325457
Name:PGKS MANAGEMENT INC
Entity Type:Organization
Organization Name:PGKS MANAGEMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PRETAM
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMPERSAUD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-227-1282
Mailing Address - Street 1:PO BOX 413
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-0413
Mailing Address - Country:US
Mailing Address - Phone:718-317-8317
Mailing Address - Fax:
Practice Address - Street 1:305 SEGUINE AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-3709
Practice Address - Country:US
Practice Address - Phone:718-227-1282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-02
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY022AA1Medicare PIN
NY021AZIMedicare PIN