Provider Demographics
NPI:1447276704
Name:HANDAGO, JOHN PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PAUL
Last Name:HANDAGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 CRYSTAL RUN RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941-7000
Mailing Address - Country:US
Mailing Address - Phone:845-703-3050
Mailing Address - Fax:845-703-3055
Practice Address - Street 1:390 CRYSTAL RUN RD
Practice Address - Street 2:SUITE 104
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941-7000
Practice Address - Country:US
Practice Address - Phone:845-703-3050
Practice Address - Fax:845-703-3055
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03547500174400000X
NY132248174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB19219Medicare UPIN
NY76A001Medicare PIN
NJ123409X5QMedicare PIN