Provider Demographics
NPI:1528497633
Name:JOHN GARGAN NP IN FAMILY HEALTH, PC
Entity type:Organization
Organization Name:JOHN GARGAN NP IN FAMILY HEALTH, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:GARGAN
Authorized Official - Suffix:III
Authorized Official - Credentials:NP
Authorized Official - Phone:917-862-1320
Mailing Address - Street 1:412 WEST 46TH STREET
Mailing Address - Street 2:4-A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036
Mailing Address - Country:US
Mailing Address - Phone:917-862-1320
Mailing Address - Fax:212-740-6742
Practice Address - Street 1:2091 AMSTERDAM AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-8210
Practice Address - Country:US
Practice Address - Phone:212-740-6740
Practice Address - Fax:212-740-6742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-08
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY334335363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100114305Medicare PIN