Healthcare Provider Details

I. General information

NPI: 1730131806
Provider Name (Legal Business Name): KAREN ANN KOGEL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 OLD COUNTRY RD BUILDING H
PLAINVIEW NY
11803-5010
US

IV. Provider business mailing address

11 DESOTO RD
AMITY HARBOR NY
11701-4009
US

V. Phone/Fax

Practice location:
  • Phone: 631-261-4400
  • Fax: 516-694-6223
Mailing address:
  • Phone: 631-789-1583
  • Fax: 516-694-6223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF331025-1
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: