Provider Demographics
NPI:1497830269
Name:ROGG, GARY I (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:I
Last Name:ROGG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:19 BRADHURST AVE
Mailing Address - Street 2:SUITE 3090N
Mailing Address - City:HAWTHORNE
Mailing Address - State:NY
Mailing Address - Zip Code:10532-2140
Mailing Address - Country:US
Mailing Address - Phone:914-592-2400
Mailing Address - Fax:914-592-2424
Practice Address - Street 1:19 BRADHURST AVE
Practice Address - Street 2:SUITE 3090N
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-2140
Practice Address - Country:US
Practice Address - Phone:914-592-2400
Practice Address - Fax:914-592-2424
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2015-02-18
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Provider Licenses
StateLicense IDTaxonomies
NY179583207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
264709927OtherHUDSON HEALTH
NY264709927OtherAFFINITY
264709927OtherPOMCO
NY01629074Medicaid
264709927OtherFIDELIS
NY666M81OtherEMPIRE BCBS
3023285OtherMVP
0272083OtherCIGNA
264709927OtherCDPHP
264709927OtherMULTIPLAN
981414OtherWELLCARE
264709927OtherMAGNACARE
NY666M81OtherEMPIRE BCBS