Provider Demographics
NPI:1659374494
Name:KOEGEL, HENRY MICHAEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:MICHAEL
Last Name:KOEGEL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 WILLOUGHBY ST
Mailing Address - Street 2:APT 3G
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-5441
Mailing Address - Country:US
Mailing Address - Phone:718-222-8799
Mailing Address - Fax:
Practice Address - Street 1:412 6TH AVE
Practice Address - Street 2:STE 612
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8409
Practice Address - Country:US
Practice Address - Phone:212-674-3998
Practice Address - Fax:212-674-3998
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013652103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2137283OtherCIGNA
NY2162442OtherCOMPSYCH
NY253346OtherVALUE OPTIONS
NY7150185OtherAETNA
NY6886128OtherGHI
NYP2461404OtherOXFORD
NY01912963Medicaid
NY246916OtherUNITED HEALTHCARE
NY274772000OtherMAGELLAN
NY013652OtherHIP
NY229997OtherMHN
NYHK0V816010OtherEMPIRE BC/BS
NY013652OtherHIP