Provider Demographics
NPI:1992860530
Name:ROGAN, MONICA L (PA)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:L
Last Name:ROGAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5645 MAIN ST
Mailing Address - Street 2:NY HOSPITAL MEDICAL CENTER OF QUEENS
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5045
Mailing Address - Country:US
Mailing Address - Phone:718-670-1426
Mailing Address - Fax:610-617-6280
Practice Address - Street 1:5645 MAIN ST
Practice Address - Street 2:NY HOSPITAL MEDICAL CENTER OF QUEENS
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5045
Practice Address - Country:US
Practice Address - Phone:718-670-1426
Practice Address - Fax:610-617-6280
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY010249363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q64943Medicare UPIN