Provider Demographics
NPI:1801339833
Name:PAGAN, MILAGROS (EI)
Entity type:Individual
Prefix:MS
First Name:MILAGROS
Middle Name:
Last Name:PAGAN
Suffix:
Gender:F
Credentials:EI
Other - Prefix:MS
Other - First Name:MILAGROS
Other - Middle Name:
Other - Last Name:PAGAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:TEACHER
Mailing Address - Street 1:6015 POLK ST
Mailing Address - Street 2:APARTMENT 1-A
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-1466
Mailing Address - Country:US
Mailing Address - Phone:917-446-1383
Mailing Address - Fax:
Practice Address - Street 1:6015 POLK ST
Practice Address - Street 2:APARTMENT 1-A
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-1466
Practice Address - Country:US
Practice Address - Phone:917-446-1383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-22
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY174400000XOtherTEACHER