Provider Demographics
NPI:1992108138
Name:KADKADE MD PLLC
Entity type:Organization
Organization Name:KADKADE MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PRAJOY
Authorized Official - Middle Name:
Authorized Official - Last Name:KADKADE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-669-7467
Mailing Address - Street 1:891 NORTHERN BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5334
Mailing Address - Country:US
Mailing Address - Phone:516-669-7467
Mailing Address - Fax:
Practice Address - Street 1:891 NORTHERN BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5334
Practice Address - Country:US
Practice Address - Phone:516-669-7467
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-02
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219617207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty