Healthcare Provider Details

I. General information

NPI: 1659374494
Provider Name (Legal Business Name): HENRY MICHAEL KOEGEL PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 6TH AVE STE 612
NEW YORK NY
10011-8409
US

IV. Provider business mailing address

191 WILLOUGHBY ST APT 3G
BROOKLYN NY
11201-5441
US

V. Phone/Fax

Practice location:
  • Phone: 212-674-3998
  • Fax: 212-674-3998
Mailing address:
  • Phone: 718-222-8799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number013652
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: