Provider Demographics
NPI:1871778902
Name:KOGAN PROSTHETICS, INC.
Entity type:Organization
Organization Name:KOGAN PROSTHETICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:KOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:CP, BOCO
Authorized Official - Phone:267-614-1538
Mailing Address - Street 1:1547 BITTERSWEET CIR
Mailing Address - Street 2:
Mailing Address - City:JAMISON
Mailing Address - State:PA
Mailing Address - Zip Code:18929-1429
Mailing Address - Country:US
Mailing Address - Phone:267-614-1538
Mailing Address - Fax:267-897-9055
Practice Address - Street 1:1547 BITTERSWEET CIR
Practice Address - Street 2:
Practice Address - City:JAMISON
Practice Address - State:PA
Practice Address - Zip Code:18929-1429
Practice Address - Country:US
Practice Address - Phone:267-614-1538
Practice Address - Fax:267-897-9055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
0002035000OtherKEYSTONE 65
0002035000OtherPERSONAL CHOICE 65
PA1012223920001Medicaid
0002035000OtherPERSONAL CHOICE
1675249OtherHIGHMARK BLUE SHIELD
PA3753541OtherAETNA
0002035000OtherKEYSTONE POINT OF SERVICE
0002035000OtherTRADITIONAL INDEMNITY
0002035000OtherKEYSTONE HEALTH PLAN EAST
PA0002035000OtherAMERIHEALTH HEALTH PLANS
PA0002035000OtherAMERIHEALTH HMO
0002035000OtherBLUE CHOICE
0002035000OtherAMERIHEALTH INSURANCE CO
PA1012223920001Medicaid