MEDICARE: DR. ELAINE G ROGERS DMD

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	1223E0200X	Endodontics	0323221	NY

General Provider Information

NPI Number	:	1235126723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELAINE G ROGERS DMD

Provider Business Mailing Address
First Line	:	5847 FRANCIS LEWIS BLVD
Second Line	:	SUITE 12
City	:	BAYSIDE
State	:	NY
Zip	:	11364
Country	:	US
Telephone Number	:	718-224-4000
Fax Number	:	718-224-1221

Provider Business Practice Location Address
First Line	:	5847 FRANCIS LEWIS BLVD
Second Line	:	SUITE 12
City	:	BAYSIDE
State	:	NY
Zip	:	11364
Country	:	US
Telephone Number	:	718-224-4000
Fax Number	:	718-224-1221

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

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	07/08/2007

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