Provider Demographics
NPI:1750657847
Name:SUNY DOWNSTATE
Entity Type:Organization
Organization Name:SUNY DOWNSTATE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:XAVIER
Authorized Official - Last Name:PAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-342-9284
Mailing Address - Street 1:7420 RIDGE BLVD
Mailing Address - Street 2:APT 1C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-2356
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7420 RIDGE BLVD
Practice Address - Street 2:APT 1C
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-2356
Practice Address - Country:US
Practice Address - Phone:787-342-9284
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-22
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural