Provider Demographics
NPI:1134761182
Name:DAGNESE, MARIYA (NP)
Entity type:Individual
Prefix:
First Name:MARIYA
Middle Name:
Last Name:DAGNESE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MARIYA
Other - Middle Name:
Other - Last Name:D'AGNESE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:30 HATFIELD LANE
Mailing Address - Street 2:ST 105
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-6768
Mailing Address - Country:US
Mailing Address - Phone:845-291-7400
Mailing Address - Fax:
Practice Address - Street 1:30 HATFIELD LANE
Practice Address - Street 2:ST 105
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-6768
Practice Address - Country:US
Practice Address - Phone:845-291-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-10
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF345010-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily