Individual
DR. ETHAN GOLOGOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
004698
NY
103TC0700X
Clinical Psychologist
004698
NY
103TE1100X
Exercise & Sports Psychologist
004698
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00921811
—
NY
01
—
0099997
GHI-CBP
NY
01
—
146126
VALUE OPTIONS
NY
01
—
176973
MHN
NY
01
—
61033707
UBH
NY
Enumeration date
02/08/2007
Last updated
03/01/2022
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