# RONALD C FAGAN MD PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134280142
- **Authorized official:** MRS. PHYLLIS NICOSIA (OFFICE MANAGER)
- **Authorized official phone:** (631) 752-7000

## Contact information

- **Practice address:** 254-41 HORACE HARDING EXPWY, LITTLE NECK, NY 11362
- **Practice address phone:** (718) 224-4100
- **Practice address fax:** (718) 224-4527
- **Mailing address:** 1111 BROADHOLLOW RD, FARMINGDALE, NY 11735-4820
- **Mailing address phone:** (631) 752-7000
- **Mailing address fax:** (631) 752-7025

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 227578 | NY | Yes |

## Other

- **Enumeration date:** 12/13/2006
- **Last updated:** 01/11/2008