Provider Demographics
NPI:1295461655
Name:MAGIDSON, KAYLIE RAE (DDS)
Entity Type:Individual
Prefix:
First Name:KAYLIE
Middle Name:RAE
Last Name:MAGIDSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 EAST 17TH STREET
Mailing Address - Street 2:5F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003
Mailing Address - Country:US
Mailing Address - Phone:403-400-3761
Mailing Address - Fax:
Practice Address - Street 1:NYU LANGONE MEDICAL CENTER
Practice Address - Street 2:550 FIRST AVE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016
Practice Address - Country:US
Practice Address - Phone:212-263-5506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-28
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program