Healthcare Provider Details

I. General information

NPI: 1316982036
Provider Name (Legal Business Name): PARAGON EMERGENCY MEDICINE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 02/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 MANOR PL
GREENPORT NY
11944-1222
US

IV. Provider business mailing address

PO BOX 3061
BRIDGEHAMPTON NY
11932-3061
US

V. Phone/Fax

Practice location:
  • Phone: 631-477-5466
  • Fax:
Mailing address:
  • Phone: 631-929-8336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number217727
License Number StateNY

VIII. Authorized Official

Name: DR. LAWRENCE RUSSELL SCHIFF
Title or Position: PRESIDENT
Credential: MD
Phone: 631-477-5466