Basic Information
| Provider Information | |||||||||
| NPI: | 1922607506 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | A'GARD | ||||||||
| FirstName: | KIRK | ||||||||
| MiddleName: | F | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7000 AUSTIN ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | FOREST HILLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113754739 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187627633 | ||||||||
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| Practice Location | |||||||||
| Address1: | 225 BROADHOLLOW RD STE 402 | ||||||||
| Address2: | |||||||||
| City: | MELVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117474899 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6313857780 | ||||||||
| FaxNumber: | 6313857795 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2020 | ||||||||
| LastUpdateDate: | 10/23/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | Y |
No ID Information.