PGR Gastro LLC

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

Legal business name

PGR GASTRO LLC

Practice address

774 Dumont PL
Valley Stream, NY 11581-3122

Phone

(718) 979-9790

Fax

(718) 979-9798

NPI assigned

Feb 15, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ross Brown

Title

Credentialing Ex

Phone

(718) 313-0438

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Pretam Ganesh Rampersaud, MD

  • Gastroenterology Physician
  • Brooklyn, NY
  • NPI 1104816685
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1613347200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690243200000",
    "number": "1073106639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "457 ALTER AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103052310",
            "telephone_number": "718-979-9790",
            "fax_number": "718-979-9798"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "774 DUMONT PL",
            "city": "VALLEY STREAM",
            "state": "NY",
            "postal_code": "115813122",
            "telephone_number": "718-979-9790",
            "fax_number": "718-979-9798"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PGR GASTRO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-15",
        "last_updated": "2023-07-25",
        "certification_date": "2023-07-25",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "ROSS",
        "authorized_official_title_or_position": "CREDENTIALING EX",
        "authorized_official_telephone_number": "718-313-0438"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QE0800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Endoscopy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Personal Quality Care Manual PT
• Tulsa Peters, LMHC, LPC
• Regine Delcarmel Petigny, LMSW
• Oleg Petrogalis
• David Pfeffer, DDS
• Phedryne Robert DDS, PLLC
• Shikha Anu Philip, RN, NP
• Wilma Philip
• Paul Philitas
• Marie Phillip

• Anatomic Pathology & Clinical Pathology Physician in Valley Stream, NY
• Providers in Valley Stream, NY by specialty
• Anatomic Pathology & Clinical Pathology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.