Healthcare Provider Details

I. General information

NPI: 1972432078
Provider Name (Legal Business Name): MICHAEL JOSEPH PAGANO CPO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 HOLLAND AVE # 121
ALBANY NY
12208-3410
US

IV. Provider business mailing address

113 HOLLAND AVE # 121
ALBANY NY
12208-3410
US

V. Phone/Fax

Practice location:
  • Phone: 518-626-5824
  • Fax: 518-626-5467
Mailing address:
  • Phone: 518-626-5824
  • Fax: 518-626-5467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberCPO03071
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: