Healthcare Provider Details

I. General information

NPI: 1760397129
Provider Name (Legal Business Name): ALLA RAGOZINA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLA GUDZ

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 EAST MAIN STREET NY
BAYSHORE NY
11706
US

IV. Provider business mailing address

51 BRIDLE WAY
FORT LEE NJ
07024-6336
US

V. Phone/Fax

Practice location:
  • Phone: 631-968-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: