Provider Demographics
NPI:1528745270
Name:SENIOR MOMENTS CARE NP IN ADULT HEALTH PLLC
Entity type:Organization
Organization Name:SENIOR MOMENTS CARE NP IN ADULT HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:E
Authorized Official - Last Name:PAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:914-552-4938
Mailing Address - Street 1:777 WESTCHESTER AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10604-3520
Mailing Address - Country:US
Mailing Address - Phone:914-383-3424
Mailing Address - Fax:
Practice Address - Street 1:777 WESTCHESTER AVE STE 101
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10604-3520
Practice Address - Country:US
Practice Address - Phone:914-383-3424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty