Healthcare Provider Details

I. General information

NPI: 1568790053
Provider Name (Legal Business Name): BOGDAN PAIN MANAGEMENT SERVICES P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2009
Last Update Date: 11/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8686 BAY PKWY SUITE M4
BROOKLYN NY
11214-5103
US

IV. Provider business mailing address

8686 BAY PKWY SUITE M4
BROOKLYN NY
11214-5103
US

V. Phone/Fax

Practice location:
  • Phone: 718-266-7700
  • Fax: 718-265-7701
Mailing address:
  • Phone: 718-266-7700
  • 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: MEDICAL DIRECTOR
Credential: M.D.
Phone: 718-266-7700