Provider Demographics
NPI:1649343914
Name:ROGER KOREEN M.D., PC
Entity type:Organization
Organization Name:ROGER KOREEN M.D., PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:KOREEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-421-4398
Mailing Address - Street 1:28 ELM ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-3402
Mailing Address - Country:US
Mailing Address - Phone:631-421-4398
Mailing Address - Fax:631-421-1914
Practice Address - Street 1:28 ELM ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3402
Practice Address - Country:US
Practice Address - Phone:631-421-4398
Practice Address - Fax:631-421-1914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY185448174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherTAX IDENTIFICATION