Provider Demographics
NPI:1326130964
Name:ROGART, WENDY ELLEN (MD)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:ELLEN
Last Name:ROGART
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:850 FULTON STREET
Mailing Address - Street 2:STE. 2
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735
Mailing Address - Country:US
Mailing Address - Phone:516-845-1600
Mailing Address - Fax:516-845-5610
Practice Address - Street 1:850 FULTON STREET STE.2
Practice Address - Street 2:PREMIER INTERNAL MEDICINE, PLLC
Practice Address - City:FARMIONGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735
Practice Address - Country:US
Practice Address - Phone:516-845-1600
Practice Address - Fax:516-845-5610
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY145685207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE17629Medicare UPIN
NY21F321Medicare ID - Type Unspecified