Healthcare Provider Details

I. General information

NPI: 1447344577
Provider Name (Legal Business Name): JAMES C FAGIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 09/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 DAKOTA DRIVE SUITE 312
LAKE SUCCESS NY
11042
US

IV. Provider business mailing address

2800 MARCUS AVE
NEW HYDE PARK NY
11042-1113
US

V. Phone/Fax

Practice location:
  • Phone: 516-608-2898
  • Fax: 516-608-2897
Mailing address:
  • Phone: 516-622-6000
  • Fax: 516-608-2897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number136140
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: