Healthcare Provider Details

I. General information

NPI: 1083835938
Provider Name (Legal Business Name): GIULIA FAGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3909 214TH PL
BAYSIDE NY
11361-2123
US

IV. Provider business mailing address

5324 213TH ST
OAKLAND GARDENS NY
11364-1824
US

V. Phone/Fax

Practice location:
  • Phone: 718-229-5757
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number052875R
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: