Healthcare Provider Details

I. General information

NPI: 1306468897
Provider Name (Legal Business Name): CAROLINA ISABEL BURGOS-PAGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2020
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 MAIN ST
HACKENSACK NJ
07601-5917
US

IV. Provider business mailing address

575 MAIN ST
HACKENSACK NJ
07601-5917
US

V. Phone/Fax

Practice location:
  • Phone: 833-377-8474
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA13232700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: