Provider Demographics
NPI:1891093977
Name:POLLY KANGANIS MD PLLC
Entity Type:Organization
Organization Name:POLLY KANGANIS MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:POLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:KANGANIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-771-9441
Mailing Address - Street 1:130 PONDFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-4015
Mailing Address - Country:US
Mailing Address - Phone:914-771-9441
Mailing Address - Fax:
Practice Address - Street 1:130 PONDFIELD RD
Practice Address - Street 2:
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-4015
Practice Address - Country:US
Practice Address - Phone:914-771-9441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-14
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY194602207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY194602OtherLICENSE NUMBER