Provider Demographics
NPI:1215029491
Name:NEWLAND PAGAN, YVONNE CYNTHIA (MD)
Entity Type:Individual
Prefix:DR
First Name:YVONNE
Middle Name:CYNTHIA
Last Name:NEWLAND PAGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:653 HARRIS ROAD
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:NY
Mailing Address - Zip Code:12734
Mailing Address - Country:US
Mailing Address - Phone:845-292-2283
Mailing Address - Fax:845-292-1466
Practice Address - Street 1:653 HARRIS ROAD
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:NY
Practice Address - Zip Code:12734
Practice Address - Country:US
Practice Address - Phone:845-292-2283
Practice Address - Fax:845-292-1466
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY160247207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01124198Medicaid
NY09Z901Medicare ID - Type Unspecified
A11645Medicare UPIN