Provider Demographics
NPI:1083133052
Name:LOGOYDA, CONNOR MICHAEL
Entity Type:Individual
Prefix:
First Name:CONNOR
Middle Name:MICHAEL
Last Name:LOGOYDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 BLOCK CT
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-4204
Mailing Address - Country:US
Mailing Address - Phone:973-294-5802
Mailing Address - Fax:
Practice Address - Street 1:7 BLOCK CT
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-4204
Practice Address - Country:US
Practice Address - Phone:973-294-5802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-11
Last Update Date:2022-07-21
Deactivation Date:2018-03-19
Deactivation Code:
Reactivation Date:2021-05-25