Provider Demographics
NPI:1699036723
Name:FOGARTY, FLORENCE
Entity Type:Individual
Prefix:MRS
First Name:FLORENCE
Middle Name:
Last Name:FOGARTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1813 WISTERIA CIR
Mailing Address - Street 2:
Mailing Address - City:BELLPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11713-3054
Mailing Address - Country:US
Mailing Address - Phone:631-539-7161
Mailing Address - Fax:
Practice Address - Street 1:1813 WISTERIA CIR
Practice Address - Street 2:
Practice Address - City:BELLPORT
Practice Address - State:NY
Practice Address - Zip Code:11713-3054
Practice Address - Country:US
Practice Address - Phone:631-539-7161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist