Healthcare Provider Details

I. General information

NPI: 1639242787
Provider Name (Legal Business Name): YVONNE C NEWLAND PAGAN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 04/25/2008
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: DR. YVONNE C NEWLAND PAGAN
Title or Position: OWNER PRESIDENT
Credential: MD
Phone: 845-292-2283