Provider Demographics
NPI:1114049053
Name:KOGAN, LIVIA A (PA)
Entity Type:Individual
Prefix:
First Name:LIVIA
Middle Name:A
Last Name:KOGAN
Suffix:
Gender:F
Credentials:PA
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Other - First Name:
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Mailing Address - Street 1:462 1ST AVE
Mailing Address - Street 2:NBV 15 SOUTH 5
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-9196
Mailing Address - Country:US
Mailing Address - Phone:212-562-3917
Mailing Address - Fax:212-263-8640
Practice Address - Street 1:462 1ST AVE
Practice Address - Street 2:NBV 15 SOUTH 5
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-9196
Practice Address - Country:US
Practice Address - Phone:212-562-3917
Practice Address - Fax:212-263-8640
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2015-10-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY011352363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant