| Custom Longevity P.a. | |
|
4005 Gulf Shore Blvd N Apt 402 Naples FL 34103-3433 | |
| (917) 292-8074 | |
| Not Available |
| Full Name | Custom Longevity P.a. |
|---|---|
| Speciality | Internal Medicine |
| Location | 4005 Gulf Shore Blvd N Apt 402, Naples, Florida |
| Authorized Official Name and Position | Svetlana Kogan (OWNER) |
| Authorized Official Contact | 9172928074 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Custom Longevity P.a. 4005 Gulf Shore Blvd N Apt 402 Naples FL 34103-3433 Ph: (917) 292-8074 | Custom Longevity P.a. 4005 Gulf Shore Blvd N Apt 402 Naples FL 34103-3433 Ph: (917) 292-8074 |
| NPI Number | 1306312731 |
|---|---|
| Provider Enumeration Date | 10/24/2018 |
| Last Update Date | 10/24/2018 |
| Medicare PECOS PAC ID | 6800132622 |
|---|---|
| Medicare Enrollment ID | O20190115001407 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306312731 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Svetlana Kogan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1023054707 PECOS PAC ID: 2769381490 Enrollment ID: I20190115002074 |
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