Boris G Kogan, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

046657 Issued in NY

Practice address

1110 Pennsylvania Ave
Suite#3
Brooklyn, NY 11207-9061

Phone

(718) 649-6677

NPI assigned

Oct 24, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Black Diamond Dental LLP

  • General Practice Dentistry
  • Brooklyn, NY
  • NPI 1558533414
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1609950872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1445 SHORE PKWY",
            "address_2": "APT.#6L",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112146145",
            "telephone_number": "917-837-5028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 PENNSYLVANIA AVE",
            "address_2": "SUITE#3",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112079061",
            "telephone_number": "718-649-6677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOGAN",
        "first_name": "BORIS",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-24",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "046657",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01682282",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Aleksandr Kogan
• Alex Kogan
• Alla Kogan, PHARMD.
• Anna Kogan, MD
• Ariel Rachel Kogan, R.N.
• Daniel Kogan
• Faina Kogan, MD
• Galina Kogan
• Gennadiy Kogan
• Gennady Kogan

• General Practice Dentistry in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.