Provider Demographics
NPI:1851603575
Name:KOGAN, REGINA (PA-C, MPAS)
Entity Type:Individual
Prefix:MS
First Name:REGINA
Middle Name:
Last Name:KOGAN
Suffix:
Gender:F
Credentials:PA-C, MPAS
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:
Other - Last Name:KOGAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C MPAS
Mailing Address - Street 1:81 WILLOUGHBY ST
Mailing Address - Street 2:DMITRY BRONFMAN MD, ATT. REGINA KOGAN
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-5291
Mailing Address - Country:US
Mailing Address - Phone:718-875-4848
Mailing Address - Fax:718-222-1709
Practice Address - Street 1:81 WILLOUGHBY ST
Practice Address - Street 2:DMITRY BRONFMAN MD, ATT. REGINA KOGAN
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5291
Practice Address - Country:US
Practice Address - Phone:718-875-4848
Practice Address - Fax:718-222-1709
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-10
Last Update Date:2015-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008147207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY008147OtherNY STATE LISENCE