Provider Demographics
NPI:1386497048
Name:KAGAN, OLGA (PHD, RN)
Entity type:Individual
Prefix:DR
First Name:OLGA
Middle Name:
Last Name:KAGAN
Suffix:
Gender:F
Credentials:PHD, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-2704
Mailing Address - Country:US
Mailing Address - Phone:516-457-4763
Mailing Address - Fax:
Practice Address - Street 1:2079 WANTAGH AVE
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-3924
Practice Address - Country:US
Practice Address - Phone:516-457-4763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY518212163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse