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General NPI Number Information
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NPI Number | 1841203775
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Entity Type | Individual
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Provider Name | JOSEPH J LOGAN DO
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Gender | Male
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Dates
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Enumeration Date | 08/14/2006
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Last Update Date | 05/16/2013
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Provider Practice Location Address
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Address Line | 55 PALMER AVE
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City | BRONXVILLE
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State | NY
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Zip | 10708-3403
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Country | US
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Telephone | 908-358-9319
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Fax |
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Provider Business Mailing Address
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Address Line | 800 WESTCHESTER AVE SUITE N-511
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City | RYE BROOK
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State | NY
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Zip | 10573-1354
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Country | US
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Telephone | 914-428-5454
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Fax | 914-428-5460
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 236696
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 25MB08581500
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License Number State | NJ
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