Healthcare Provider Details

I. General information

NPI: 1467489625
Provider Name (Legal Business Name): NOLAN J KAGETSU M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 11/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 10TH AVENUE
NEW YORK NY
10019
US

IV. Provider business mailing address

10 EXCHANGE PL 14TH FLOOR - WSBS
JERSEY CITY NJ
07302-3918
US

V. Phone/Fax

Practice location:
  • Phone: 212-590-2930
  • Fax: 212-590-2982
Mailing address:
  • Phone: 212-590-2982
  • Fax: 212-590-2982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number166260
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2085R0205X
TaxonomyRadiological Physics Physician
License Number166260
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: