Active NPI
Leonard Jay Fagen, RPH
- Pharmacist
- Southampton, NY
National Provider Identifier
1942522776
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 26998
- Practice address
- 111 Main St
Southampton, NY 11968-4810 - Phone
- (631) 283-4250
- NPI assigned
- Feb 21, 2010
- Last updated
- Feb 21, 2010
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 26998 | NY | Primary |
| Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P0018X | 26998 | NY |
Addresses
Primary practice location
111 Main St
Southampton, NY 11968-4810
Mailing address
50 Roy Dr
Nesconset, NY 11767-2227
Phone (631) 360-0236
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
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26998 | NY | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| CVS Albany LLC | Past | Accepting new patients | |
| CVS Albany LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1266710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1266710400000",
"number": "1942522776",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "50 ROY DR",
"city": "NESCONSET",
"state": "NY",
"postal_code": "117672227",
"telephone_number": "631-360-0236"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "111 MAIN ST",
"city": "SOUTHAMPTON",
"state": "NY",
"postal_code": "119684810",
"telephone_number": "631-283-4250"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAGEN",
"first_name": "LEONARD",
"middle_name": "JAY",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-02-21",
"last_updated": "2010-02-21",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "26998",
"primary": true
},
{
"code": "1835P0018X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
"state": "NY",
"license": "26998",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Southampton, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.