Individual
VIVIEN JIEWEN HOGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
300 COMMUNITY DR, MANHASSET, NY 11030-3816
(516) 684-7341
Mailing address
86 VALENTINE ST, GLEN COVE, NY 11542-2334
(917) 293-6586
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
020429
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020429
NYS LICENSE
NY
Enumeration date
11/18/2016
Last updated
01/03/2020
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