Provider Demographics
NPI:1285981738
Name:HOGAN, PHYLLIS (APN)
Entity type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:
Last Name:HOGAN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 BROAD ST
Mailing Address - Street 2:STE 0815
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10004-2415
Mailing Address - Country:US
Mailing Address - Phone:347-761-3168
Mailing Address - Fax:
Practice Address - Street 1:75 BROAD ST
Practice Address - Street 2:STE 0815
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004-2415
Practice Address - Country:US
Practice Address - Phone:347-761-3168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-14
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY306059-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health