Provider Demographics
NPI:1932227279
Name:CHILDREN'S HOSPITAL OF NY PRESBYTERIAN
Entity Type:Organization
Organization Name:CHILDREN'S HOSPITAL OF NY PRESBYTERIAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:MISS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ROGOZA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CPNP
Authorized Official - Phone:212-342-8530
Mailing Address - Street 1:180 MANNING AVE
Mailing Address - Street 2:
Mailing Address - City:RIVER EDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07661-2123
Mailing Address - Country:US
Mailing Address - Phone:201-967-0667
Mailing Address - Fax:212-342-8541
Practice Address - Street 1:3959 BROADWAY
Practice Address - Street 2:5 TOWER
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-1559
Practice Address - Country:US
Practice Address - Phone:212-342-8530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF381650282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN32004Medicare UPIN