Provider Demographics
NPI:1427610021
Name:K & K BROADWAY INC.
Entity type:Organization
Organization Name:K & K BROADWAY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SVETLANA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAGANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-833-8777
Mailing Address - Street 1:111 BROADWAY RM 1405
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10006-3903
Mailing Address - Country:US
Mailing Address - Phone:212-204-8111
Mailing Address - Fax:718-646-8400
Practice Address - Street 1:111 BROADWAY RM 1405
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10006-3903
Practice Address - Country:US
Practice Address - Phone:212-204-8111
Practice Address - Fax:718-646-8400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-03
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty