Provider Demographics
NPI:1730113697
Name:ROGERS, CAROL J (NP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:J
Last Name:ROGERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:104 UNION AVE
Mailing Address - Street 2:SUITE 806
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-2761
Mailing Address - Country:US
Mailing Address - Phone:315-474-0542
Mailing Address - Fax:315-474-4340
Practice Address - Street 1:104 UNION AVE
Practice Address - Street 2:SUITE 806
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-2761
Practice Address - Country:US
Practice Address - Phone:315-474-0542
Practice Address - Fax:315-474-4340
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY300376363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02328403Medicaid
NYS99122Medicare UPIN
NY02328403Medicaid