Provider Demographics
NPI:1285023390
Name:KOGUT, HELEN (PA-C)
Entity Type:Individual
Prefix:
First Name:HELEN
Middle Name:
Last Name:KOGUT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:763 OCEAN PKWY
Mailing Address - Street 2:5A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-2267
Mailing Address - Country:US
Mailing Address - Phone:718-859-0833
Mailing Address - Fax:
Practice Address - Street 1:763 OCEAN PKWY
Practice Address - Street 2:5A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-2267
Practice Address - Country:US
Practice Address - Phone:718-859-0833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018333363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant