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General NPI Number Information
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NPI Number | 1336265941
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Entity Type | Organization
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Legal Business Name | JOHN P HANDAGO PHYSICIAN PC
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 08/07/2008
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Provider Practice Location Address
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Address Line | 390 CRYSTAL RUN RD 104
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City | MIDDLETOWN
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State | NY
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Zip | 10941-7000
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Country | US
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Telephone | 845-703-3050
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Fax | 845-703-3055
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Provider Business Mailing Address
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Address Line | 390 CRYSTAL RUN RD SUITE 104
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City | MIDDLETOWN
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State | NY
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Zip | 10941-4050
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Country | US
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Telephone | 845-703-3050
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Fax | 845-703-3055
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN PAUL HANDAGO
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Credential | M.D.
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Telephone | 845-703-3050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 132248
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License Number State | NY
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