Provider Demographics
NPI:1508855792
Name:KAGAN, POLINA (MD)
Entity Type:Individual
Prefix:
First Name:POLINA
Middle Name:
Last Name:KAGAN
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 1:556 MERRICK RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-5487
Mailing Address - Country:US
Mailing Address - Phone:516-255-2044
Mailing Address - Fax:516-255-2045
Practice Address - Street 1:556 MERRICK RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-5487
Practice Address - Country:US
Practice Address - Phone:516-255-2044
Practice Address - Fax:516-255-2045
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY191486207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01732118Medicaid
NY13G491Medicare ID - Type Unspecified
NY01732118Medicaid