Provider Demographics
NPI:1962747741
Name:KOGAN, SIMONA (NP)
Entity type:Individual
Prefix:MRS
First Name:SIMONA
Middle Name:
Last Name:KOGAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:SIMONA
Other - Middle Name:
Other - Last Name:ROKHLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2915 WEST 5TH STREET
Mailing Address - Street 2:APT. 12F
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224
Mailing Address - Country:US
Mailing Address - Phone:646-267-7194
Mailing Address - Fax:
Practice Address - Street 1:2915 WEST 5TH STREET
Practice Address - Street 2:APT. 12F
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224
Practice Address - Country:US
Practice Address - Phone:646-267-7194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-04
Last Update Date:2022-05-11
Deactivation Date:2014-06-16
Deactivation Code:
Reactivation Date:2022-05-04
Provider Licenses
StateLicense IDTaxonomies
NY662029163W00000X
NY343627363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse