Provider Demographics
NPI:1952586117
Name:BRYAN B. KAGAN, DPM
Entity Type:Organization
Organization Name:BRYAN B. KAGAN, DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:KAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:914-682-8828
Mailing Address - Street 1:122 W POST RD
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10606-2937
Mailing Address - Country:US
Mailing Address - Phone:914-682-8828
Mailing Address - Fax:914-682-4026
Practice Address - Street 1:122 W POST RD
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10606-2937
Practice Address - Country:US
Practice Address - Phone:914-682-8828
Practice Address - Fax:914-682-4026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN3093213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1105360001Medicare NSC