Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | ||
Y | 103G00000X | Clinical Psychologist | 017818 | NY |
Y | 103TC0700X | Clinical Psychologist | 017818 | NY |
NPI | 1629237888 |
---|---|
Provider Name | Dr. John P Pasagiannis |
First Address | New York, NY 10024-6450 |
Second Address | New York, NY 10024-6450 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2008 |
Last Update Date | 21/10/2008 |