Provider Demographics
NPI:1639665706
Name:HAGANS, CARLOS A (BSN-RN)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:A
Last Name:HAGANS
Suffix:
Gender:M
Credentials:BSN-RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 COURT ST STE 210
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-4233
Mailing Address - Country:US
Mailing Address - Phone:315-507-5800
Mailing Address - Fax:315-507-5802
Practice Address - Street 1:502 COURT ST STE 210
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-4233
Practice Address - Country:US
Practice Address - Phone:315-507-5800
Practice Address - Fax:315-507-5802
Is Sole Proprietor?:No
Enumeration Date:2018-07-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY733603163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB3261QM1300XMedicaid