Healthcare Provider Details

I. General information

NPI: 1275457988
Provider Name (Legal Business Name): ROSE KOGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15014 78TH RD
FLUSHING NY
11367-3540
US

IV. Provider business mailing address

15014 78TH RD
FLUSHING NY
11367-3540
US

V. Phone/Fax

Practice location:
  • Phone: 917-617-4652
  • Fax:
Mailing address:
  • Phone: 917-617-4652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: