Provider Demographics
NPI:1386755817
Name:GARJIAN, PEGGY ANN (MD)
Entity type:Individual
Prefix:
First Name:PEGGY ANN
Middle Name:
Last Name:GARJIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 TODT HILL RD
Mailing Address - Street 2:STE 201
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-4534
Mailing Address - Country:US
Mailing Address - Phone:718-720-1030
Mailing Address - Fax:718-720-1684
Practice Address - Street 1:71 TODT HILL RD
Practice Address - Street 2:STE 201
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-4534
Practice Address - Country:US
Practice Address - Phone:718-720-1030
Practice Address - Fax:718-720-1684
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY151980207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B11779Medicare UPIN
00E651/00E652Medicare ID - Type Unspecified