Provider Demographics
NPI:1639660129
Name:PAGAN, FERNANDO JOSEPH
Entity Type:Individual
Prefix:
First Name:FERNANDO
Middle Name:JOSEPH
Last Name:PAGAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 W 38TH ST FL 6
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-9537
Mailing Address - Country:US
Mailing Address - Phone:212-810-4075
Mailing Address - Fax:
Practice Address - Street 1:307 W 38TH ST FL 6
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-9537
Practice Address - Country:US
Practice Address - Phone:212-810-4075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-21
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator