Provider Demographics
NPI:1841240249
Name:FOGELMAN, JOHN AARON (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:AARON
Last Name:FOGELMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DANVILLE CT
Mailing Address - Street 2:
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-1102
Mailing Address - Country:US
Mailing Address - Phone:845-623-7760
Mailing Address - Fax:845-623-4520
Practice Address - Street 1:1 DANVILLE CT
Practice Address - Street 2:
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-1102
Practice Address - Country:US
Practice Address - Phone:845-623-7760
Practice Address - Fax:845-623-4520
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0976822084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB19833Medicare UPIN
NYB19833Medicare UPIN