Provider Demographics
NPI:1407872179
Name:KOGON, JAY STUART (PT)
Entity type:Individual
Prefix:MR
First Name:JAY
Middle Name:STUART
Last Name:KOGON
Suffix:
Gender:
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2542 BERWYN RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-3500
Mailing Address - Country:US
Mailing Address - Phone:302-479-0301
Mailing Address - Fax:302-479-9004
Practice Address - Street 1:3300 CONCORD PIKE STE 4
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-5038
Practice Address - Country:US
Practice Address - Phone:302-753-2700
Practice Address - Fax:302-478-1975
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0000423225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE57287OtherAETNA
DEG00338Medicare ID - Type Unspecified