Healthcare Provider Details

I. General information

NPI: 1346908373
Provider Name (Legal Business Name): ANTHONY JOSEPH PAGANO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2021
Last Update Date: 12/07/2021
Certification Date: 12/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

473 FDR DR
NEW YORK NY
10002-1135
US

IV. Provider business mailing address

2709 154TH STREET
FLUSHING NY
11354
US

V. Phone/Fax

Practice location:
  • Phone: 212-475-2000
  • Fax:
Mailing address:
  • Phone: 917-364-8436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number048311
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: