Individual
DR. MARK FAGELMAN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11 MEDICAL PARK DR, SUITE 101, POMONA, NY 10970-3559
(845) 354-5800
(845) 354-5966
Mailing address
11 MEDICAL PARK DR, SUITE 101, POMONA, NY 10970-3559
(845) 354-5800
(845) 354-5966
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
102803
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00178047
—
NY
Enumeration date
06/14/2006
Last updated
07/08/2007
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