Active NPI
Mitchell Ernest Fagan, M.A. SLP-CCC
- Speech-Language Pathologist
- Brooklyn, NY
National Provider Identifier
1144636234
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 15304
- Practice address
- 820 Hancock St
Brooklyn, NY 11233-1309 - Phone
- (718) 218-2444
- NPI assigned
- Jul 9, 2014
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 15304 | OR | Primary |
Addresses
Primary practice location
820 Hancock St
Brooklyn, NY 11233-1309
Mailing address
820 Hancock St
Brooklyn, NY 11233-1309
Phone (718) 218-2444
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15304 | OR | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1404864000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1730073600000",
"number": "1144636234",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "820 HANCOCK ST",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112331309",
"telephone_number": "718-218-2444"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "820 HANCOCK ST",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112331309",
"telephone_number": "718-218-2444"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAGAN",
"first_name": "MITCHELL",
"middle_name": "ERNEST",
"credential": "M.A. SLP-CCC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-07-09",
"last_updated": "2024-10-28",
"certification_date": "2024-10-28",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "OR",
"license": "15304",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.