Provider Demographics
NPI:1326290743
Name:THE ROGOSIN INSTITUTE, INC
Entity Type:Organization
Organization Name:THE ROGOSIN INSTITUTE, INC
Other - Org Name:CLINICAL LABORATORY
Other - Org Type:Other Name
Authorized Official - Title/Position:CHEIF OPERATING OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:R
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-746-1554
Mailing Address - Street 1:504-506 EAST 74TH STREET
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-3486
Mailing Address - Country:US
Mailing Address - Phone:646-317-0684
Mailing Address - Fax:212-249-4659
Practice Address - Street 1:310 EAST 67TH STREET
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6275
Practice Address - Country:US
Practice Address - Phone:212-570-3220
Practice Address - Fax:212-570-3083
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE ROGOSIN INSTITUTE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-16
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33D0653383291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYL86211Medicare PIN