Provider Demographics
NPI:1790247377
Name:KAGAN, JEFFREY GREGORY (DPM)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:GREGORY
Last Name:KAGAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 HEMPSTEAD TPKE STE 110
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010-3636
Mailing Address - Country:US
Mailing Address - Phone:516-352-4454
Mailing Address - Fax:
Practice Address - Street 1:925 HEMPSTEAD TPKE STE 110
Practice Address - Street 2:
Practice Address - City:FRANKLIN SQUARE
Practice Address - State:NY
Practice Address - Zip Code:11010-3636
Practice Address - Country:US
Practice Address - Phone:516-352-4454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-03
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN007229-01213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery