Provider Demographics
NPI:1205128972
Name:FOREST HILLS AMBULATORY MEDICAL CARE PLLC
Entity type:Organization
Organization Name:FOREST HILLS AMBULATORY MEDICAL CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MIKHAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:KOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-544-1171
Mailing Address - Street 1:7211 AUSTIN ST # 481
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-5354
Mailing Address - Country:US
Mailing Address - Phone:718-544-1171
Mailing Address - Fax:
Practice Address - Street 1:10818 72ND AVE
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-5339
Practice Address - Country:US
Practice Address - Phone:718-544-1171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty