Provider Demographics
NPI:1982650453
Name:TROGAN, IGOR (MD)
Entity Type:Individual
Prefix:DR
First Name:IGOR
Middle Name:
Last Name:TROGAN
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 1:220 BRIDGE PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-1729
Mailing Address - Country:US
Mailing Address - Phone:732-972-9525
Mailing Address - Fax:732-972-9055
Practice Address - Street 1:220 BRIDGE PLAZA DR
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-1729
Practice Address - Country:US
Practice Address - Phone:732-972-9525
Practice Address - Fax:732-972-9055
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2010-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07580300208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0026646Medicaid
I25991Medicare UPIN
NJ0026646Medicaid