Provider Demographics
NPI:1508046301
Name:ROGAK, PAUL (PA)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:
Last Name:ROGAK
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NICOLLS RD
Mailing Address - Street 2:STONYBROOK UNIVERSITY DEPT OF NEUROSURGERY
Mailing Address - City:STONYBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794
Mailing Address - Country:US
Mailing Address - Phone:631-444-8070
Mailing Address - Fax:
Practice Address - Street 1:NICOLLS RD
Practice Address - Street 2:STONYBROOK UNIVERSITY DEPT OF NEUROSURGERY
Practice Address - City:STONYBROOK
Practice Address - State:NY
Practice Address - Zip Code:11794
Practice Address - Country:US
Practice Address - Phone:631-444-8070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-08
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004801363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant