Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 204688 | NY |
NPI | 1053311209 |
---|---|
Provider Name | Maureen Brogan |
First Address | Scarsdale, NY 10583-4911 |
Second Address | Bronx, NY 10467-2404 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2005 |
Last Update Date | 16/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02176507 | (05) | NY |
A400062882 | MEDICARE PTAN (01) | NY |
A400062887 | MEDICARE PTAN (01) | NY |