Healthcare Provider Details

I. General information

NPI: 1619812005
Provider Name (Legal Business Name): ANGEL LUIS PAGAN FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

591 FRANKLIN AVE
NUTLEY NJ
07110-1284
US

IV. Provider business mailing address

3724 S VILLAGE DR
AVENEL NJ
07001-1074
US

V. Phone/Fax

Practice location:
  • Phone: 973-916-0002
  • Fax:
Mailing address:
  • Phone: 917-755-8739
  • Fax: 917-755-8739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number26NJ15491400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: