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PGR GASTRO LLC
NPI 1073106639
Pathology - Anatomic Pathology & Clinical Pathology in Valley Stream, NY

Active since February 15, 2021CLIA 33D2177176 · Certificate of Compliance
774 DUMONT PL, VALLEY STREAM, NY 11581(718) 979-9790(718) 979-9798 Get Directions Write a Review

NPPES record last updated: July 25, 2023. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Jul 25, 2023, Feb 15, 2021 (2 updates tracked since 2021).

About Pgr Gastro Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PGR GASTRO LLC (NPI 1073106639) is a healthcare organization registered as an anatomic pathology & clinical pathology in Valley Stream, New York and active in the NPI registry since February 2021. The organization holds a CLIA Certificate of Compliance certificate valid through March 26, 2027 and lists Ross Brown, Credentialing Ex, as its authorized official.

NPPES Registry Identity

NPI1073106639
Entity TypeOrganization
Primary Taxonomy207ZP0102X
Legal Business NamePGR GASTRO LLC
Location Address774 DUMONT PLValley Stream, NY 11581-3122
Mailing Address457 Alter AveStaten Island, NY 10305-2310 · (718) 979-9790 · Fax (718) 979-9798
Phone(718) 979-9790
Fax(718) 979-9798
Organization SubpartNo
Authorized OfficialRoss BrownCredentialing Ex · (718) 313-0438
Enumeration DateFebruary 15, 2021
Last NPPES UpdateJuly 25, 20232 updates tracked since enumeration
NPPES CertifiedJuly 25, 2023
✔ NPI 1073106639 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPathology · Anatomic Pathology & Clinical PathologyAllopathic & Osteopathic Physicians
Taxonomy Code207ZP0102X
Definition

A pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis and treatment through knowledge gained by the laboratory application of the biologic, chemical and physical sciences. A pathologist uses information gathered from the microscopic examination of tissue specimens, cells and body fluids, and from clinical laboratory tests on body fluids and secretions for the diagnosis, exclusion and monitoring of disease.

Also ListedClinic/Center · EndoscopyTaxonomy 261QE0800X
774 DUMONT PL, Valley Stream, NY 11581
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CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Compliance 33D2177176

Pgr Gastro, LLC · Staten Island, NY
Active · expires Mar 26, 2027
CLIA Number33D2177176
Laboratory TypePhysician Office
Certificate Effective DateJanuary 7, 2020
Certificate Expiration DateMarch 26, 2027
Laboratory DirectorImrana M. Ali
Laboratory Phone(718) 979-9790
Laboratory LocationPgr Gastro, LLC457 Alter Avenue, Staten Island, NY 10305
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

GRSP MANAGEMENT
Internal Medicine (Gastroenterology)
774 DUMONT PL
VALLEY STREAM, NY 11581
Nassau County (732) 281-3590

Frequently Asked Questions

What is PGR GASTRO LLC's NPI number?

The NPI number assigned to this healthcare provider is 1073106639, enumerated as an "organization" on February 15, 2021.

Where is the provider located?

The provider is located at 774 DUMONT PL VALLEY STREAM, NY 11581 and the phone number is (718) 979-9790.

What is the provider's specialty?

Pathology with taxonomy code 207ZP0102X and a focus in Anatomic Pathology & Clinical Pathology.