Basic Information
Provider Information
NPI: 1649403338
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HIGGINS
FirstName: PAULINE
MiddleName:  
NamePrefix: MRS.
NameSuffix:  
Credential: PA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 316 E 30TH ST
Address2: 2ND FLOOR
City: NEW YORK
State: NY
PostalCode: 100168303
CountryCode: US
TelephoneNumber: 2126140039
FaxNumber: 2122539631
Practice Location
Address1: 32 E 32ND ST FL 9
Address2:  
City: NEW YORK
State: NY
PostalCode: 100165503
CountryCode: US
TelephoneNumber: 2127252660
FaxNumber: 2126844712
Other Information
ProviderEnumerationDate: 08/27/2009
LastUpdateDate: 04/26/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/26/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363AM0700X003988-1NYY Physician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical

No ID Information.


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