Provider Demographics
NPI:1932281219
Name:KAGAN, PETER EVAN (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:EVAN
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 1:101 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1911
Mailing Address - Country:US
Mailing Address - Phone:201-342-7979
Mailing Address - Fax:201-342-8549
Practice Address - Street 1:101 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1911
Practice Address - Country:US
Practice Address - Phone:201-342-7979
Practice Address - Fax:201-342-8549
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA07158500208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJI16957Medicare UPIN
NJ083657Medicare ID - Type Unspecified