Healthcare Provider Details

I. General information

NPI: 1568646982
Provider Name (Legal Business Name): SERGEY V. BOGDAN, MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2007
Last Update Date: 01/14/2020
Certification Date: 01/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8686 BAY PKWY STE M4
BROOKLYN NY
11214-5193
US

IV. Provider business mailing address

62 KEUNE CT
STATEN ISLAND NY
10304-1431
US

V. Phone/Fax

Practice location:
  • Phone: 718-265-7700
  • Fax: 718-265-7701
Mailing address:
  • Phone: 718-265-7700
  • Fax: 718-265-7701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: IRINA BOGDAN
Title or Position: PRACTICE MANAGER
Credential:
Phone: 718-265-7700