Provider Demographics
NPI:1538563424
Name:HAGAN, PATRICK
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:HAGAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8036 COOPER AVE
Mailing Address - Street 2:NG 2
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-7727
Mailing Address - Country:US
Mailing Address - Phone:718-275-5954
Mailing Address - Fax:718-275-1250
Practice Address - Street 1:8036 COOPER AVE
Practice Address - Street 2:NG 2
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-7727
Practice Address - Country:US
Practice Address - Phone:718-275-5954
Practice Address - Fax:718-275-1250
Is Sole Proprietor?:No
Enumeration Date:2014-10-21
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14000026620237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY461163452OtherEIN