Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 086937 | NY |
NPI | 1881718617 |
---|---|
Provider Name | Dr. Lawrence J. Kagen |
First Address | Bronx, NY 10463-3314 |
Second Address | Bronx, NY 10463-3314 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
086937 | LICENSE (01) | NY |