Individual
MRS. KOGIE JOHNSON INGERSOLL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1005 BURKE AVE FL 2, BRONX, NY 10469-3803
(914) 733-8011
Mailing address
1005 BURKE AVE FL 2, BRONX, NY 10469-3803
(914) 733-8011
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
AEC-16-04979
NY
Other
Enumeration date
04/26/2018
Last updated
04/26/2018
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