Provider Demographics
NPI:1649289968
Name:COGAN, FREDRIC (MD)
Entity type:Individual
Prefix:DR
First Name:FREDRIC
Middle Name:
Last Name:COGAN
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 1:176 TULIP AVE
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-2838
Mailing Address - Country:US
Mailing Address - Phone:516-488-1414
Mailing Address - Fax:
Practice Address - Street 1:176 TULIP AVE
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-2838
Practice Address - Country:US
Practice Address - Phone:516-488-1414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY137406207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYO8E552Medicare ID - Type UnspecifiedEMPIRE
NYE39915Medicare UPIN