Provider Demographics
NPI:1669695896
Name:ROGOVIN, KAREN SUSAN (MA)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:SUSAN
Last Name:ROGOVIN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2355 BELL BLVD
Mailing Address - Street 2:APT 6E
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-2058
Mailing Address - Country:US
Mailing Address - Phone:718-225-7655
Mailing Address - Fax:
Practice Address - Street 1:2355 BELL BLVD
Practice Address - Street 2:APT 6E
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-2058
Practice Address - Country:US
Practice Address - Phone:718-225-7655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005088235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist