Provider Demographics
NPI:1992463814
Name:PAGAN, MICHAEL TINO (LMT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:TINO
Last Name:PAGAN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 ODELL AVE APT 4N
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10703-1141
Mailing Address - Country:US
Mailing Address - Phone:914-357-6060
Mailing Address - Fax:
Practice Address - Street 1:495 ODELL AVE APT 4N
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10703-1141
Practice Address - Country:US
Practice Address - Phone:914-357-6060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032203225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist