Healthcare Provider Details

I. General information

NPI: 1225928484
Provider Name (Legal Business Name): JAGMEET K KANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2025
Last Update Date: 07/08/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NYS OFFICE OF MENTAL HEALTH 75 NEW SCOTLAND AVE
ALBANY NY
12208
US

IV. Provider business mailing address

122 FASULA BLVD
SCHENECTADY NY
12303-4336
US

V. Phone/Fax

Practice location:
  • Phone: 518-243-9406
  • Fax:
Mailing address:
  • Phone: 518-243-9406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0600X
TaxonomyInfection Control Registered Nurse
License Number756524-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: