Healthcare Provider Details

I. General information

NPI: 1871778902
Provider Name (Legal Business Name): KOGAN PROSTHETICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2008
Last Update Date: 01/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1547 BITTERSWEET CIR
JAMISON PA
18929-1429
US

IV. Provider business mailing address

1547 BITTERSWEET CIR
JAMISON PA
18929-1429
US

V. Phone/Fax

Practice location:
  • Phone: 267-614-1538
  • Fax: 267-897-9055
Mailing address:
  • Phone: 267-614-1538
  • Fax: 267-897-9055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier0002035000
Identifier TypeOTHER
Identifier State
Identifier IssuerKEYSTONE 65
# 2
Identifier0002035000
Identifier TypeOTHER
Identifier State
Identifier IssuerPERSONAL CHOICE 65
# 3
Identifier1012223920001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 4
Identifier0002035000
Identifier TypeOTHER
Identifier State
Identifier IssuerPERSONAL CHOICE
# 5
Identifier1675249
Identifier TypeOTHER
Identifier State
Identifier IssuerHIGHMARK BLUE SHIELD
# 6
Identifier3753541
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerAETNA
# 7
Identifier0002035000
Identifier TypeOTHER
Identifier State
Identifier IssuerKEYSTONE POINT OF SERVICE
# 8
Identifier0002035000
Identifier TypeOTHER
Identifier State
Identifier IssuerTRADITIONAL INDEMNITY
# 9
Identifier0002035000
Identifier TypeOTHER
Identifier State
Identifier IssuerKEYSTONE HEALTH PLAN EAST
# 10
Identifier0002035000
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerAMERIHEALTH HEALTH PLANS
# 11
Identifier0002035000
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerAMERIHEALTH HMO
# 12
Identifier0002035000
Identifier TypeOTHER
Identifier State
Identifier IssuerBLUE CHOICE
# 13
Identifier0002035000
Identifier TypeOTHER
Identifier State
Identifier IssuerAMERIHEALTH INSURANCE CO

VIII. Authorized Official

Name: MICHAEL TODD KOGAN
Title or Position: PRESIDENT
Credential: CP, BOCO
Phone: 267-614-1538