Provider Demographics
NPI:1639242787
Name:YVONNE C NEWLAND PAGAN MD PC
Entity Type:Organization
Organization Name:YVONNE C NEWLAND PAGAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:C
Authorized Official - Last Name:NEWLAND PAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-292-2283
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY160247207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01124198Medicaid
A11645Medicare UPIN
NY01124198Medicaid
NY09Z901Medicare PIN