Provider Demographics
NPI:1477732923
Name:GOGOR, UCHENNA C (PMHNP)
Entity type:Individual
Prefix:
First Name:UCHENNA
Middle Name:C
Last Name:GOGOR
Suffix:
Gender:
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 RYE RIDGE PLZ # 326
Mailing Address - Street 2:
Mailing Address - City:RYE BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:10573-2822
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7 RYE RIDGE PLZ # 326
Practice Address - Street 2:
Practice Address - City:RYE BROOK
Practice Address - State:NY
Practice Address - Zip Code:10573-2822
Practice Address - Country:US
Practice Address - Phone:718-519-7672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-01
Last Update Date:2025-03-08
Deactivation Date:2016-04-11
Deactivation Code:
Reactivation Date:2020-08-25
Provider Licenses
StateLicense IDTaxonomies
NY406883363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02913500Medicaid