Healthcare Provider Details

I. General information

NPI: 1467420877
Provider Name (Legal Business Name): MIKHAIL KOGAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 IRVING PL 10TH FLOOR
NEW YORK NY
10003-2202
US

IV. Provider business mailing address

299 LIVINGSTON ST
BROOKLYN NY
11217-1001
US

V. Phone/Fax

Practice location:
  • Phone: 212-254-5350
  • Fax:
Mailing address:
  • Phone: 201-804-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA204869-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberA204869-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: