Provider Demographics
NPI:1689197014
Name:MIRA KAGA MD LLC
Entity Type:Organization
Organization Name:MIRA KAGA MD LLC
Other - Org Name:THE KAGA INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-719-2001
Mailing Address - Street 1:58 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746-1451
Mailing Address - Country:US
Mailing Address - Phone:732-719-2001
Mailing Address - Fax:732-719-2002
Practice Address - Street 1:58 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MARLBORO
Practice Address - State:NJ
Practice Address - Zip Code:07746-1451
Practice Address - Country:US
Practice Address - Phone:732-719-2001
Practice Address - Fax:732-719-2002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-18
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty