Provider Demographics
NPI:1821333626
Name:KOGAN, ZOE (LAC)
Entity Type:Individual
Prefix:
First Name:ZOE
Middle Name:
Last Name:KOGAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 8TH AVE APT 2D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-3547
Mailing Address - Country:US
Mailing Address - Phone:718-230-0583
Mailing Address - Fax:
Practice Address - Street 1:641 PRESIDENT ST
Practice Address - Street 2:SUITE 204
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-1523
Practice Address - Country:US
Practice Address - Phone:718-230-0583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00134-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist