Healthcare Provider Details

I. General information

NPI: 1740564905
Provider Name (Legal Business Name): VALLEY PSYCHOLOGICAL, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2011
Last Update Date: 02/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 STERLING ST
BROOKLYN NY
11225-3416
US

IV. Provider business mailing address

169 STERLING ST
BROOKLYN NY
11225-3416
US

V. Phone/Fax

Practice location:
  • Phone: 914-419-0088
  • Fax:
Mailing address:
  • Phone: 914-419-0088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number003552
License Number StateNY

VIII. Authorized Official

Name: DR. JONATHAN BERNARD KOGEN
Title or Position: OWNER
Credential: PHD
Phone: 914-419-0088