Provider Demographics
NPI:1336265941
Name:JOHN P HANDAGO PHYSICIAN PC
Entity Type:Organization
Organization Name:JOHN P HANDAGO PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:HANDAGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-703-3050
Mailing Address - Street 1:390 CRYSTAL RUN RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941-4050
Mailing Address - Country:US
Mailing Address - Phone:845-703-3050
Mailing Address - Fax:845-703-3055
Practice Address - Street 1:390 CRYSTAL RUN RD
Practice Address - Street 2:104
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941-7000
Practice Address - Country:US
Practice Address - Phone:845-703-3050
Practice Address - Fax:845-703-3055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY132248174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY200001223Medicare PIN
NYWWP271Medicare PIN