Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 231545-01 | NY |
NPI | 1003015785 |
---|---|
Provider Name | Dr. Ryan W. Rogers |
First Address | Bronx, NY 10458-1265 |
Second Address | New York, NY 10065-7369 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2007 |
Last Update Date | 03/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
188836401 | (05) | TX |
188836403 | MEDICAID/EAST (01) | TX |
8J8523 | MEDICARE/MP1 (01) | TX |
8J8524 | MEDICARE/EAST (01) | TX |