Healthcare Provider Details

I. General information

NPI: 1417123886
Provider Name (Legal Business Name): TANYA ORIE ROGO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2008
Last Update Date: 07/20/2021
Certification Date: 07/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1276 FULTON AVE RM 208
BRONX NY
10456-3402
US

IV. Provider business mailing address

1276 FULTON AVE RM 208
BRONX NY
10456-3402
US

V. Phone/Fax

Practice location:
  • Phone: 171-890-1891
  • Fax: 718-901-8918
Mailing address:
  • Phone: 718-901-8918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number13436
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number288135
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License NumberMD13436
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: