Healthcare Provider Details

I. General information

NPI: 1588598114
Provider Name (Legal Business Name): JULIAN KOGUT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2930 W 5TH ST APT 19L
BROOKLYN NY
11224-4841
US

IV. Provider business mailing address

2930 W 5TH ST APT 19L
BROOKLYN NY
11224-4841
US

V. Phone/Fax

Practice location:
  • Phone: 718-213-7272
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: