Provider Demographics
NPI:1265462931
Name:KAGZANOVA, ANDZHELIKA (DO)
Entity Type:Individual
Prefix:DR
First Name:ANDZHELIKA
Middle Name:
Last Name:KAGZANOVA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 AVENUE K
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-4904
Mailing Address - Country:US
Mailing Address - Phone:718-859-6786
Mailing Address - Fax:866-481-4658
Practice Address - Street 1:1908 AVENUE K
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-4904
Practice Address - Country:US
Practice Address - Phone:718-859-6786
Practice Address - Fax:866-481-4658
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226925207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02404915Medicaid
NYH87416Medicare UPIN
NYWCW721Medicare ID - Type UnspecifiedGROUP
NY135AD1Medicare ID - Type UnspecifiedINDIVIDUAL