NPIMap

Organization Active NPI

Mark Fagelman, M.D., P.C.

  • Ambulatory Surgical Clinic/Center
  • Pomona, NY
National Provider Identifier
1306093364
Registry record updated Aug 21, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
102803 Issued in NY
Legal business name
MARK FAGELMAN, M.D., P.C.
Practice address
11 Medical Park Dr
Suite 101
Pomona, NY 10970-3559
Phone
(845) 354-5800
Fax
(845) 354-5966
NPI assigned
Aug 21, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Mark Fagelman, M.D.NPI 1497798896
Title
Urologist
Phone
(845) 354-5800

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 102803 NY Primary

Addresses

Primary practice location

11 Medical Park Dr
Suite 101
Pomona, NY 10970-3559

Mailing address

11 Medical Park Drive
Suite 101
Pomona, NY 10970
Phone (845) 354-5800

Other identifiers 2

IdentifierTypeStateIssuer
00178047MedicaidNY
02154667MedicaidNY

National Provider Directory

National Provider Directory

Locations

11 Medical Park Dr
Ste 101
Pomona, NY 10970
Phone (845) 354-1064

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1219276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1219276800000",
    "number": "1306093364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 MEDICAL PARK DRIVE",
            "address_2": "SUITE 101",
            "city": "POMONA",
            "state": "NY",
            "postal_code": "10970",
            "telephone_number": "845-354-5800",
            "fax_number": "845-354-5966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 MEDICAL PARK DR",
            "address_2": "SUITE 101",
            "city": "POMONA",
            "state": "NY",
            "postal_code": "109703559",
            "telephone_number": "845-354-5800",
            "fax_number": "845-354-5966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK FAGELMAN, M.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-21",
        "last_updated": "2008-08-21",
        "status": "A",
        "authorized_official_last_name": "FAGELMAN",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "UROLOGIST",
        "authorized_official_telephone_number": "845-354-5800",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NY",
            "license": "102803",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00178047",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02154667",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pomona, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.