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Kevin Mike Gangadyal

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

PECOS Enrollment

This provider is enrolled in PECOS as KEVIN GANGADYAL.

Based on the most recent information from CMS, provider Kevin Mike Gangadyal is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records today at 9:43 AM.

Profile Details

Provider ID
1679223564
Provider Type
Individual
Full Name
Gangadyal, Kevin Mike
Credential
PA-C

Gender
Male
Sole Proprietor
No
Enumeration Date
3/24/2022
Last Updated
5/26/2023

Contact Information

Practice Location

150 55th St, Brooklyn, NY 11220-2508

(718) 630-7000

Unlisted Fax

Mailing Location

150 55th St, Brooklyn, NY 11220-2508

Unlisted Phone

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363A00000X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License 028063 New York

Kevin Mike Gangadyal

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Garbulsky, Michael

Badrian, Solomon

Huang, Xin Yan

Iorio, Kerrin C.

Perez Espinal, Karina Maria

Murillo, Andrew J

Liu, Yan Hong

Zhang, Jinyan

Von Euler, Sarah Lillian

Ouyang, Aimin