Healthcare Provider Details

I. General information

NPI: 1235126723
Provider Name (Legal Business Name): ELAINE G ROGERS DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5847 FRANCIS LEWIS BLVD SUITE 12
BAYSIDE NY
11364
US

IV. Provider business mailing address

5847 FRANCIS LEWIS BLVD SUITE 12
BAYSIDE NY
11364
US

V. Phone/Fax

Practice location:
  • Phone: 718-224-4000
  • Fax: 718-224-1221
Mailing address:
  • Phone: 718-224-4000
  • Fax: 718-224-1221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number0323221
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: