Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 0491131 | NY |
NPI | 1760465918 |
---|---|
Provider Name | Elena Kogan |
First Address | Port Washington, NY 11050-2205 |
Second Address | Great Neck, NY 11021-5306 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2005 |
Last Update Date | 08/07/2007 |