Healthcare Provider Details

I. General information

NPI: 1760022073
Provider Name (Legal Business Name): BOHDAN HLADUN RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

10 HORIZON DR
HUNTINGTON NY
11743-4411
US

IV. Provider business mailing address

10 HORIZON DR
HUNTINGTON NY
11743-4411
US

V. Phone/Fax

Practice location:
  • Phone: 347-279-8763
  • Fax:
Mailing address:
  • Phone: 347-279-8763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number776837
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: