Healthcare Provider Details

I. General information

NPI: 1780917690
Provider Name (Legal Business Name): BOGDAN SURGERY CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2009
Last Update Date: 05/26/2020
Certification Date: 05/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 PROFESSIONAL VIEW DR BLDG 100
FREEHOLD NJ
07728-7902
US

IV. Provider business mailing address

62 KEUNE CT
STATEN ISLAND NY
10304-1431
US

V. Phone/Fax

Practice location:
  • Phone: 732-577-9126
  • Fax: 732-577-9127
Mailing address:
  • Phone: 718-265-7700
  • Fax: 718-265-7701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SERGEY BOGDAN
Title or Position: OWNER
Credential: M.D.
Phone: 732-577-9126