Healthcare Provider Details

I. General information

NPI: 1609110113
Provider Name (Legal Business Name): WILLIAM EDWARD BOGGIANO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2012
Last Update Date: 11/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 MAPLE AVE
FRANKLINVILLE NY
14737-1314
US

IV. Provider business mailing address

7 MAPLE AVE PO BOX 196
FRANKLINVILLE NY
14737-1314
US

V. Phone/Fax

Practice location:
  • Phone: 716-676-2056
  • Fax:
Mailing address:
  • Phone: 716-676-2056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number146322-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number146322-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: