Healthcare Provider Details

I. General information

NPI: 1215029491
Provider Name (Legal Business Name): YVONNE CYNTHIA NEWLAND PAGAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

653 HARRIS ROAD
FERNDALE NY
12734
US

IV. Provider business mailing address

653 HARRIS ROAD
FERNDALE NY
12734
US

V. Phone/Fax

Practice location:
  • Phone: 845-292-2283
  • Fax: 845-292-1466
Mailing address:
  • Phone: 845-292-2283
  • Fax: 845-292-1466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number160247
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: