Provider Demographics
NPI:1871369702
Name:LAGACE, KATERINA (PA-C)
Entity type:Individual
Prefix:
First Name:KATERINA
Middle Name:
Last Name:LAGACE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1317 3RD AVE FL 7
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-2957
Mailing Address - Country:US
Mailing Address - Phone:212-570-1816
Mailing Address - Fax:212-570-0819
Practice Address - Street 1:1317 3RD AVE # 1707
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-2995
Practice Address - Country:US
Practice Address - Phone:212-570-1816
Practice Address - Fax:212-570-0819
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-01
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032117207RG0100X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology