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General NPI Number Information
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NPI Number | 1306093364
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Entity Type | Organization
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Legal Business Name | MARK FAGELMAN, M.D., P.C.
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Dates
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Enumeration Date | 08/21/2008
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Last Update Date | 08/21/2008
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Provider Practice Location Address
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Address Line | 11 MEDICAL PARK DR SUITE 101
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City | POMONA
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State | NY
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Zip | 10970-3559
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Country | US
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Telephone | 845-354-5800
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Fax | 845-354-5966
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Provider Business Mailing Address
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Address Line | 11 MEDICAL PARK DRIVE SUITE 101
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City | POMONA
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State | NY
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Zip | 10970
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Country | US
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Telephone | 845-354-5800
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Fax | 845-354-5966
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Authorized Official
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Title or Position | UROLOGIST
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Name | DR. MARK FAGELMAN
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Credential | M.D.
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Telephone | 845-354-5800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 102803
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License Number State | NY
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