MEDICARE: ROBERT KOGAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	25MA04336900	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114003936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT KOGAN M.D.

Provider Business Mailing Address
First Line	:	700 N BROAD ST
Second Line	:
City	:	ELIZABETH
State	:	NJ
Zip	:	07208-2310
Country	:	US
Telephone Number	:	908-354-1045
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 N BROAD ST
Second Line	:
City	:	ELIZABETH
State	:	NJ
Zip	:	07208-2310
Country	:	US
Telephone Number	:	908-354-1045
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	03/11/2014

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