Healthcare Provider Details

I. General information

NPI: 1174652705
Provider Name (Legal Business Name): MR. JAY PAGIRSKY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2193 BROADWAY
NEW YORK NY
10024-6611
US

IV. Provider business mailing address

2193 BROADWAY
NEW YORK NY
10024-6611
US

V. Phone/Fax

Practice location:
  • Phone: 212-877-2980
  • Fax: 212-877-0549
Mailing address:
  • Phone: 212-877-2980
  • Fax: 212-877-0549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number004678
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: