Provider Demographics
NPI:1144946385
Name:KAGAN PODIATRY P.C.
Entity type:Organization
Organization Name:KAGAN PODIATRY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:G
Authorized Official - Last Name:KAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:516-712-6262
Mailing Address - Street 1:61 ELTON RD
Mailing Address - Street 2:
Mailing Address - City:STEWART MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:11530-3808
Mailing Address - Country:US
Mailing Address - Phone:516-712-6262
Mailing Address - Fax:
Practice Address - Street 1:61 ELTON RD
Practice Address - Street 2:
Practice Address - City:STEWART MANOR
Practice Address - State:NY
Practice Address - Zip Code:11530-3808
Practice Address - Country:US
Practice Address - Phone:516-712-6262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric