Provider Demographics
NPI:1285670125
Name:AGIN, CAROLE (MD)
Entity type:Individual
Prefix:DR
First Name:CAROLE
Middle Name:
Last Name:AGIN
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 1:2800 MARCUS AVENUE
Mailing Address - Street 2:
Mailing Address - City:LAKE SUCCESS
Mailing Address - State:NY
Mailing Address - Zip Code:11042
Mailing Address - Country:US
Mailing Address - Phone:516-622-6000
Mailing Address - Fax:
Practice Address - Street 1:3 DELAWARE DRIVE
Practice Address - Street 2:
Practice Address - City:LAKE SUCCESS
Practice Address - State:NY
Practice Address - Zip Code:11042-3495
Practice Address - Country:US
Practice Address - Phone:516-622-6105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174472207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4214595OtherAETNA
NY8L0091OtherEMPIRE BC.BS
NY01607469Medicaid
NY8L0091OtherEMPIRE BC.BS
NY01607469Medicaid