Healthcare Provider Details

I. General information

NPI: 1053419135
Provider Name (Legal Business Name): BOGDAN P SASARAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 11/12/2021
Certification Date: 11/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PARK ST
GLENS FALLS NY
12801-4413
US

IV. Provider business mailing address

100 PARK ST
GLENS FALLS NY
12801-4413
US

V. Phone/Fax

Practice location:
  • Phone: 518-926-3265
  • Fax: 518-926-3273
Mailing address:
  • Phone: 518-926-3265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number217019-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number217019
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: