Basic Information
Provider Information | |||||||||
NPI: | 1649492950 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BAGDONAS | ||||||||
FirstName: | REBECCA | ||||||||
MiddleName: | LYNN | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 550 | ||||||||
Address2: | 2 CATHARINE ST INFIRMARY ANESTHESIA ASSOCIATES LLP | ||||||||
City: | POUGHKEEPSIE | ||||||||
State: | NY | ||||||||
PostalCode: | 12602 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8668688415 | ||||||||
FaxNumber: | 8457902675 | ||||||||
Practice Location | |||||||||
Address1: | 310 E 14TH STREET | ||||||||
Address2: | NY EYE & EAR INFIRMARY | ||||||||
City: | NEW YORK | ||||||||
State: | NY | ||||||||
PostalCode: | 10003 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2129794000 | ||||||||
FaxNumber: | 8457902675 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/03/2007 | ||||||||
LastUpdateDate: | 11/19/2008 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 2288041 | NY | Y |   | Allopathic & Osteopathic Physicians | Anesthesiology |   | 207LP3000X | 2288041 | NY | N |   | Allopathic & Osteopathic Physicians | Anesthesiology | Pediatric Anesthesiology |
ID Information
ID | Type | State | Issuer | Description | 02899356 | 05 | NY |   | MEDICAID |