Organization
GAVRIIL AGAON, M.D., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GAVRIIL AGAON M.D. (PRESIDENT)
(718) 532-3131
Entity
Organization
Contact information
Practice address
9972 66TH RD, SUITE - LH, REGO PARK, NY 11374-4460
(718) 532-3131
(718) 997-8040
Mailing address
6715 102ND ST, APT - 7T, FOREST HILLS, NY 11375-2453
(718) 275-3370
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
222861
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02243589
—
NY
01
—
05035
MEDICARE PROVIDER NUMBER
NY
Enumeration date
01/26/2011
Last updated
01/26/2011
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