Individual provider Active NPI

Stefanie Beth Kagan

  • Pediatrics Physician
  • Forest Hills, NY
National Provider Identifier
1891292546
Registry record updated May 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
309505 Issued in NY
Practice address
10615 Queens Blvd Apt 5M
Forest Hills, NY 11375-4375
Phone
(718) 930-6616
NPI assigned
Apr 10, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 14, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 309505 NY Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

10615 Queens Blvd Apt 5M
Forest Hills, NY 11375-4375

Mailing address

10615 Queens Blvd Apt 5M
Forest Hills, NY 11375-4375

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250603002415 NY Practitioner - Pediatric Medicine 9335658129 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
309505NYMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore Lij, Urgent Care, P.C. CurrentSince May 29, 2025 Accepting new patients
PM Pediatrics PC Pediatrics Past Accepting new patients
PM Pediatrics of Mamaroneck Past Accepting new patients

Locations

5555 Glenridge Connector
Ste 700
Sandy Springs, GA 30342
Phone (470) 567-7780

5828 99th St
Flushing, NY 11368
Phone (718) 502-9867

71 Forest Ave
Glen Cove, NY 11542
Phone (347) 493-2941

1332 Peninsula Blvd
Hewlett, NY 11557
Phone (516) 531-6130

377 S Oyster Bay Rd
Plainview, NY 11803
Phone (516) 537-9061

377 S Oyster Bay Rd
#13202
Plainview, NY 11803
Phone (516) 537-9061

Interoperability endpoints

  • Direct secure messaging: stefanie.kagan@ghuc.eclinicaldirectplus.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1523318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747180800000",
    "number": "1891292546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10615 QUEENS BLVD APT 5M",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113754375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10615 QUEENS BLVD APT 5M",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113754375",
            "telephone_number": "718-930-6616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAGAN",
        "first_name": "STEFANIE",
        "middle_name": "BETH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-10",
        "last_updated": "2025-05-14",
        "certification_date": "2025-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "309505",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Forest Hills, NY

Sources for this page

Verify at the official NPI Registry.