1902855075 NPI number — PAUL NORMAN ROGOW D.D.S.

Table of content: PAUL NORMAN ROGOW D.D.S. (NPI 1902855075)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902855075 NPI number — PAUL NORMAN ROGOW D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROGOW
Provider First Name:
PAUL
Provider Middle Name:
NORMAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902855075
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2094 ALBANY POST RD
Provider Second Line Business Mailing Address:
VA HUDSON VALLEY HEALTH CARE SYSTEM
Provider Business Mailing Address City Name:
MONTROSE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10548-1454
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-737-4400
Provider Business Mailing Address Fax Number:
914-788-4317

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2094 ALBANY POST RD
Provider Second Line Business Practice Location Address:
VA HUDSON VALLEY HEALTH CARE SYSTEM
Provider Business Practice Location Address City Name:
MONTROSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10548-1454
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-737-4400
Provider Business Practice Location Address Fax Number:
914-788-4317
Provider Enumeration Date:
05/08/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X , with the licence number:  029385-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)