Provider Demographics
NPI:1104940873
Name:PAGANO, KARYN (PA)
Entity type:Individual
Prefix:
First Name:KARYN
Middle Name:
Last Name:PAGANO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 PORTION RD
Mailing Address - Street 2:SUITE 11W
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-2299
Mailing Address - Country:US
Mailing Address - Phone:631-736-4321
Mailing Address - Fax:631-736-4370
Practice Address - Street 1:1055 PORTION RD
Practice Address - Street 2:SUITE 11W
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738-2299
Practice Address - Country:US
Practice Address - Phone:631-736-4321
Practice Address - Fax:631-736-4370
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011373363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical