Provider Demographics
NPI:1144374380
Name:KOGAN, FAINA (MD)
Entity type:Individual
Prefix:MRS
First Name:FAINA
Middle Name:
Last Name:KOGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 FIR DR
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-2405
Mailing Address - Country:US
Mailing Address - Phone:516-484-6847
Mailing Address - Fax:
Practice Address - Street 1:280 QUENTIN RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-1628
Practice Address - Country:US
Practice Address - Phone:718-336-4499
Practice Address - Fax:718-336-2013
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207111207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01793035Medicaid
NY30N201Medicare ID - Type Unspecified
NYG62371Medicare UPIN