Provider Demographics
NPI:1033449319
Name:HOGAN, AMBER JEMAY (MSPA)
Entity Type:Individual
Prefix:MS
First Name:AMBER
Middle Name:JEMAY
Last Name:HOGAN
Suffix:
Gender:F
Credentials:MSPA
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:22 W 25TH ST
Mailing Address - Street 2:APT 4B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-2714
Mailing Address - Country:US
Mailing Address - Phone:509-680-4599
Mailing Address - Fax:
Practice Address - Street 1:10 PLAZA ST E
Practice Address - Street 2:SUITE 1E
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-4954
Practice Address - Country:US
Practice Address - Phone:347-564-3211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-08
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant