Individual
DR. ETHAN GOLOGOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
340 E. 93 ST, 21E, NEW YORK, NY 10128-5555
(212) 737-0072
Mailing address
340 E. 93 ST., APT. 21E, NEW YORK, NY 10128-5555
(212) 737-0072
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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