Provider Demographics
NPI:1073563870
Name:FARRAGHER, PATRICIA (DPM)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:FARRAGHER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-1311
Mailing Address - Country:US
Mailing Address - Phone:845-255-5454
Mailing Address - Fax:845-255-5455
Practice Address - Street 1:222 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-1311
Practice Address - Country:US
Practice Address - Phone:845-255-5454
Practice Address - Fax:845-255-5455
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005180213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1945344Medicaid
NYP063712085Medicare PIN
NYA300128687Medicare PIN
NYA400133389Medicare PIN
NYU67904Medicare UPIN