Healthcare Provider Details

I. General information

NPI: 1801419346
Provider Name (Legal Business Name): REBECCA MICHELLE KOGAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2020
Last Update Date: 05/19/2020
Certification Date: 05/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 EAST 74TH ST
NEW YORK NY
10021
US

IV. Provider business mailing address

21 BARRY CT
STATEN ISLAND NY
10306-5675
US

V. Phone/Fax

Practice location:
  • Phone: 212-639-2000
  • Fax:
Mailing address:
  • Phone: 718-810-0511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number698183
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: