Provider Demographics
NPI:1891733713
Name:DELERME-PAGAN, CATHY (MD)
Entity Type:Individual
Prefix:DR
First Name:CATHY
Middle Name:
Last Name:DELERME-PAGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20215 46TH RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-3059
Mailing Address - Country:US
Mailing Address - Phone:718-423-2141
Mailing Address - Fax:
Practice Address - Street 1:321 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-2427
Practice Address - Country:US
Practice Address - Phone:718-484-8985
Practice Address - Fax:718-484-8986
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY198983207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02458597Medicaid