Healthcare Provider Details

I. General information

NPI: 1164515680
Provider Name (Legal Business Name): BOGUSLAWA GELA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 11/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 WESTCHESTER AVE
BRONX NY
10462-5072
US

IV. Provider business mailing address

19 CARLTON ROAD
BRONXVILLE NY
10708
US

V. Phone/Fax

Practice location:
  • Phone: 718-409-8854
  • Fax: 718-794-1525
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number194857
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: