Active NPI
Jennifer Joy Fagan, COTA
- Specialist
- Newburgh, NY
National Provider Identifier
1144363151
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 006651
- Practice address
- 1607 Route 300 Ste 102
Newburgh, NY 12550-1738 - Phone
- (845) 564-9853
- Fax
- (845) 564-6974
- NPI assigned
- Feb 15, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 006651 | NY | Primary |
Addresses
Primary practice location
1607 Route 300 Ste 102
Newburgh, NY 12550-1738
Mailing address
17 Winchester Way
Washingtonville, NY 10992-1741
Phone (845) 496-1459
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 006651 | NY | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171497600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1144363151",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17 WINCHESTER WAY",
"city": "WASHINGTONVILLE",
"state": "NY",
"postal_code": "109921741",
"telephone_number": "845-496-1459"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1607 ROUTE 300 STE 102",
"city": "NEWBURGH",
"state": "NY",
"postal_code": "125501738",
"telephone_number": "845-564-9853",
"fax_number": "845-564-6974"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAGAN",
"first_name": "JENNIFER",
"middle_name": "JOY",
"name_prefix": "Mrs.",
"credential": "COTA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-02-15",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "NY",
"license": "006651",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Newburgh, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.