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Organization
PGR GASTRO LLC
Active
Organization
PGR GASTRO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROSS BROWN (CREDENTIALING EX)
(718) 313-0438
Entity
Organization
Contact information
Practice address
774 DUMONT PL, VALLEY STREAM, NY 11581-3122
(718) 979-9790
(718) 979-9798
Mailing address
457 ALTER AVE, STATEN ISLAND, NY 10305-2310
(718) 979-9790
(718) 979-9798
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
261QE0800X
Endoscopy Clinic/Center
—
—
Other
Enumeration date
02/15/2021
Last updated
07/25/2023
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