Healthcare Provider Details

I. General information

NPI: 1518037639
Provider Name (Legal Business Name): DIANE E PAGAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 WESTCHESTER AVE
WEST HARRISON NY
10604
US

IV. Provider business mailing address

2700 WESTCHESTER AVE
PURCHASE NY
10577-2547
US

V. Phone/Fax

Practice location:
  • Phone: 914-682-6532
  • Fax: 914-681-5260
Mailing address:
  • Phone: 914-607-5730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF302198
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: