1932215290 NPI number — MONICA M ROGALSKI DO

Table of content: MONICA M ROGALSKI DO (NPI 1932215290)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932215290 NPI number — MONICA M ROGALSKI DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROGALSKI
Provider First Name:
MONICA
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

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:
1932215290
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/03/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
399 COUNTY ROUTE 22
Provider Second Line Business Mailing Address:
RENASCENT HEALTH CENTER
Provider Business Mailing Address City Name:
HUDSON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12534-3266
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-828-5656
Provider Business Mailing Address Fax Number:
518-822-9288

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
399 CRT 22
Provider Second Line Business Practice Location Address:
RENASCENT HEALTH CENTER
Provider Business Practice Location Address City Name:
HUDSON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12534
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-828-5656
Provider Business Practice Location Address Fax Number:
518-822-9288
Provider Enumeration Date:
08/21/2006

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: 204D00000X , with the licence number:  203485-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: 203485-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2034858 . This is a "WCB" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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