Provider Demographics
NPI:1477644698
Name:KANGANIS, POLLY (MD)
Entity Type:Individual
Prefix:
First Name:POLLY
Middle Name:
Last Name:KANGANIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 RESEARCH WAY STE 208A
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-6401
Mailing Address - Country:US
Mailing Address - Phone:631-675-2175
Mailing Address - Fax:
Practice Address - Street 1:200 E MAIN ST STE 1E
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2812
Practice Address - Country:US
Practice Address - Phone:631-265-4567
Practice Address - Fax:631-265-4704
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY194602207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology