Healthcare Provider Details

I. General information

NPI: 1306008651
Provider Name (Legal Business Name): BRETT JOSEPH HOGAN ACNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2008
Last Update Date: 07/06/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE
ROCHESTER NY
14642-0001
US

IV. Provider business mailing address

1008 ROOSEVELT RD
EAST ROCHESTER NY
14445-2024
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-1218
  • Fax:
Mailing address:
  • Phone: 585-329-0249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number430399
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: