Provider Demographics
NPI:1386900181
Name:DRAGON, KASHA
Entity type:Individual
Prefix:
First Name:KASHA
Middle Name:
Last Name:DRAGON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 SMITH STREET
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-4528
Mailing Address - Country:US
Mailing Address - Phone:516-233-8640
Mailing Address - Fax:
Practice Address - Street 1:17 SMITH STREET
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-4528
Practice Address - Country:US
Practice Address - Phone:516-233-8640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYBN12001306332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies