Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 036094 | NY |
N | 1223E0200X | Endodontist | 036094 | NY |
N | 1223G0001X | General Practice | 036094 | NY |
N | 213EG0000X | General Practice | 036094 | NY |
N | 1223P0700X | Prosthodontist | 036094 | NY |
NPI | 1093737231 |
---|---|
Provider Name | Steven Gary Pergola |
First Address | Hempstead, NY 11551-1850 |
Second Address | East Meadow, NY 11554-1859 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 08/07/2007 |