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General NPI Number Information
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NPI Number | 1447343868
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Entity Type | Organization
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Legal Business Name | MIKHAIL KOGAN PHYSICIAN, PC
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Dates
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Enumeration Date | 09/30/2006
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Last Update Date | 07/17/2008
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Provider Practice Location Address
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Address Line | 9785 QUEENS BLVD
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City | REGO PARK
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State | NY
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Zip | 11374-3319
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Country | US
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Telephone | 718-261-9100
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Fax |
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Provider Business Mailing Address
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Address Line | 65 FIR DR
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City | ROSLYN
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State | NY
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Zip | 11576-2405
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/ OWNER
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Name | MIKHAIL KOGAN
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Credential |
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Telephone | 212-255-2333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 204869
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License Number State | NY
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