Basic Information
| Provider Information | |||||||||
| NPI: | 1558997759 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GARGANO | ||||||||
| FirstName: | ANDREW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7119 80TH ST STE 8303 | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113857733 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182755954 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7119 80TH ST STE 8303 | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113857733 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182755954 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2020 | ||||||||
| LastUpdateDate: | 03/19/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | 14000061048 | NY | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.