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NPI Code Detail

MEDICARE: LEONARD JAY FAGEN RPH

MEDICARE: LEONARD JAY FAGEN RPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist26998NY
21835P0018XPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist26998NY

General Provider Information

NPI Number : 1942522776
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEONARD JAY FAGEN RPH
Provider Business Mailing Address
First Line : 50 ROY DR
Second Line :
City : NESCONSET
State : NY
Zip : 11767-2227
Country : US
Telephone Number : 631-360-0236
Fax Number :
Provider Business Practice Location Address
First Line : 111 MAIN ST
Second Line :
City : SOUTHAMPTON
State : NY
Zip : 11968-4810
Country : US
Telephone Number : 631-283-4250
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2010
Last Update Date : 02/21/2010

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