Provider Demographics
NPI:1497971519
Name:PAGAN, MIGUEL A JR (DC)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:A
Last Name:PAGAN
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 BROADWAY STE 511
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07514-1530
Mailing Address - Country:US
Mailing Address - Phone:973-782-4198
Mailing Address - Fax:973-782-4199
Practice Address - Street 1:680 BROADWAY STE 511
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07514-1530
Practice Address - Country:US
Practice Address - Phone:973-782-4198
Practice Address - Fax:973-782-4199
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00583800111N00000X
NJ40QA01631800261QP2000X
NJ38MC000583800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty