Provider Demographics
NPI:1679511257
Name:KAGAN, EDUARD (MD)
Entity Type:Individual
Prefix:
First Name:EDUARD
Middle Name:
Last Name:KAGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HOLLOW LANE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:LAKE SUCCESS
Mailing Address - State:NY
Mailing Address - Zip Code:11042
Mailing Address - Country:US
Mailing Address - Phone:516-931-0041
Mailing Address - Fax:
Practice Address - Street 1:1324 MOTOR PKWY
Practice Address - Street 2:
Practice Address - City:ISLANDIA
Practice Address - State:NY
Practice Address - Zip Code:11749-5262
Practice Address - Country:US
Practice Address - Phone:631-963-7700
Practice Address - Fax:631-232-0147
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA0780492085R0001X
NY2471682085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02959942Medicaid
NJ0049603Medicaid
NJ085930Medicare ID - Type Unspecified
NJ085930AHEMedicare PIN