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General NPI Number Information
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NPI Number | 1134280142
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Entity Type | Organization
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Legal Business Name | RONALD C FAGAN MD PC
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 01/11/2008
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Provider Practice Location Address
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Address Line | 254-41 HORACE HARDING EXPWY
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City | LITTLE NECK
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State | NY
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Zip | 11362
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Country | US
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Telephone | 718-224-4100
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Fax | 718-224-4527
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Provider Business Mailing Address
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Address Line | 1111 BROADHOLLOW RD
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City | FARMINGDALE
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State | NY
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Zip | 11735-4820
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Country | US
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Telephone | 631-752-7000
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Fax | 631-752-7025
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. PHYLLIS NICOSIA
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Credential |
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Telephone | 631-752-7000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 227578
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License Number State | NY
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