Healthcare Provider Details

I. General information

NPI: 1093951600
Provider Name (Legal Business Name): JAY HARVEY ROGOVE DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2009
Last Update Date: 01/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 THORNWOOD DR
DIX HILLS NY
11746-6439
US

IV. Provider business mailing address

18 THORNWOOD DR
DIX HILLS NY
11746-6439
US

V. Phone/Fax

Practice location:
  • Phone: 631-242-8728
  • Fax:
Mailing address:
  • Phone: 631-242-8728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number003115
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: