Provider Demographics
NPI:1437493947
Name:ROGO, GERALD (DC)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:
Last Name:ROGO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-8939
Mailing Address - Country:US
Mailing Address - Phone:845-615-1593
Mailing Address - Fax:845-615-1593
Practice Address - Street 1:66 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-8939
Practice Address - Country:US
Practice Address - Phone:845-615-1593
Practice Address - Fax:845-615-1593
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-21
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005534-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor