Provider Demographics
NPI:1720976657
Name:GAWARGY, MARCO ADLY MEEKHAIL (PT)
Entity type:Individual
Prefix:
First Name:MARCO
Middle Name:ADLY MEEKHAIL
Last Name:GAWARGY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 W 174TH ST APT 2A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-7711
Mailing Address - Country:US
Mailing Address - Phone:615-710-0712
Mailing Address - Fax:
Practice Address - Street 1:1785 FOREST AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10303-2107
Practice Address - Country:US
Practice Address - Phone:646-820-5669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-27
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054180225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty