Provider Demographics
NPI:1629237888
Name:PASAGIANNIS, JOHN P (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:PASAGIANNIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 W 79TH ST
Mailing Address - Street 2:#1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-6450
Mailing Address - Country:US
Mailing Address - Phone:917-715-6357
Mailing Address - Fax:
Practice Address - Street 1:175 W 79TH ST
Practice Address - Street 2:#1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-6450
Practice Address - Country:US
Practice Address - Phone:917-715-6357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TA0400X
NY017818103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)