Provider Demographics
NPI:1316929318
Name:HOGBEN, GEORGE L (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:L
Last Name:HOGBEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 MILTON RD
Mailing Address - Street 2:
Mailing Address - City:RYE
Mailing Address - State:NY
Mailing Address - Zip Code:10580-3850
Mailing Address - Country:US
Mailing Address - Phone:914-967-3144
Mailing Address - Fax:914-967-3144
Practice Address - Street 1:66 MILTON RD
Practice Address - Street 2:
Practice Address - City:RYE
Practice Address - State:NY
Practice Address - Zip Code:10580-3850
Practice Address - Country:US
Practice Address - Phone:914-967-3144
Practice Address - Fax:914-967-3144
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0922312084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00148476Medicaid
NYB15039Medicare UPIN
NY00148476Medicaid