Provider Demographics
NPI:1225188105
Name:PAGNINI, PAUL G (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:G
Last Name:PAGNINI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 E 68TH ST # 46
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-4870
Mailing Address - Country:US
Mailing Address - Phone:212-746-3600
Mailing Address - Fax:212-746-8749
Practice Address - Street 1:525 E 68TH ST RM 46
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-4870
Practice Address - Country:US
Practice Address - Phone:212-746-3608
Practice Address - Fax:818-241-2946
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG852532085R0001X
NY3184492085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G852530Medicaid
CAHW12175Medicare PIN
CAWG85253CMedicare ID - Type UnspecifiedINDIVIDUAL MEDICARE
CAH02412Medicare UPIN