Provider Demographics
NPI:1093951600
Name:ROGOVE, JAY HARVEY (DPM)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:HARVEY
Last Name:ROGOVE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 THORNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-6439
Mailing Address - Country:US
Mailing Address - Phone:631-242-8728
Mailing Address - Fax:
Practice Address - Street 1:18 THORNWOOD DR
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-6439
Practice Address - Country:US
Practice Address - Phone:631-242-8728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-02
Last Update Date:2009-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003115213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery