Provider Demographics
NPI:1073598561
Name:HOGAN, ELIZABETH ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ANNE
Last Name:HOGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7717 STUYVESANT AVE
Mailing Address - Street 2:ANN KLEIN FORENSIC CENTER
Mailing Address - City:WEST TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08628-0717
Mailing Address - Country:US
Mailing Address - Phone:609-633-0916
Mailing Address - Fax:609-633-1030
Practice Address - Street 1:7717 STUYVESANT AVE
Practice Address - Street 2:ANN KLEIN FORENSIC CENTER
Practice Address - City:WEST TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08628-0717
Practice Address - Country:US
Practice Address - Phone:609-633-0916
Practice Address - Fax:609-633-1030
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2008-09-24
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2008-09-24
Provider Licenses
StateLicense IDTaxonomies
NJ25MA068648002084F0202X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH60724Medicare UPIN