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General NPI Number Information
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NPI Number | 1467145706
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Entity Type | Individual
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Provider Name | MARTIN FAGIN PHD
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Gender | Male
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Dates
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Enumeration Date | 06/01/2023
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Last Update Date | 06/28/2023
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Provider Practice Location Address
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Address Line | 264 FURNACE DOCK RD
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City | CORTLANDT MANOR
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State | NY
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Zip | 10567-6508
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Country | US
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Telephone | 718-687-0940
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Fax |
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Provider Business Mailing Address
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Address Line | 264 FURNACE DOCK RD
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City | CORTLANDT MANOR
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State | NY
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Zip | 10567-6508
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Country | US
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Telephone | 718-687-0940
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 025678
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License Number State | NY
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