Provider Demographics
NPI:1467489625
Name:KAGETSU, NOLAN J (MD)
Entity Type:Individual
Prefix:
First Name:NOLAN
Middle Name:J
Last Name:KAGETSU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10 EXCHANGE PL
Mailing Address - Street 2:14TH FLOOR - WSBS
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-3918
Mailing Address - Country:US
Mailing Address - Phone:212-590-2982
Mailing Address - Fax:212-590-2982
Practice Address - Street 1:1000 10TH AVENUE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019
Practice Address - Country:US
Practice Address - Phone:212-590-2930
Practice Address - Fax:212-590-2982
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1662602085R0205X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0205XAllopathic & Osteopathic PhysiciansRadiologyRadiological Physics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01256880Medicaid
NY62F721Medicare ID - Type Unspecified
NY01256880Medicaid