Basic Information
| Provider Information | |||||||||
| NPI: | 1417123886 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROGO | ||||||||
| FirstName: | TANYA | ||||||||
| MiddleName: | ORIE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1276 FULTON AVE RM 208 | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104563402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189018918 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1276 FULTON AVE RM 208 | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104563402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1718901891 | ||||||||
| FaxNumber: | 7189018918 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2008 | ||||||||
| LastUpdateDate: | 07/20/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 13436 | RI | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 288135 | NY | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0208X | MD13436 | RI | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Infectious Diseases |
ID Information
| ID | Type | State | Issuer | Description | 939025129 | 01 | RI | RI MEDICARE GROUP | OTHER |