Provider Demographics
NPI:1508633843
Name:COGAN, ALECIA JOY (RD)
Entity Type:Individual
Prefix:
First Name:ALECIA
Middle Name:JOY
Last Name:COGAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 HAUGHWOUT AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10302-2607
Mailing Address - Country:US
Mailing Address - Phone:917-524-4679
Mailing Address - Fax:
Practice Address - Street 1:18 HAUGHWOUT AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10302-2607
Practice Address - Country:US
Practice Address - Phone:917-524-4679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86153435133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered