Healthcare Provider Details

I. General information

NPI: 1932215290
Provider Name (Legal Business Name): MONICA M ROGALSKI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 06/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 CRT 22 RENASCENT HEALTH CENTER
HUDSON NY
12534
US

IV. Provider business mailing address

399 COUNTY ROUTE 22 RENASCENT HEALTH CENTER
HUDSON NY
12534-3266
US

V. Phone/Fax

Practice location:
  • Phone: 518-828-5656
  • Fax: 518-822-9288
Mailing address:
  • Phone: 518-828-5656
  • Fax: 518-822-9288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number203485-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number203485-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: