Healthcare Provider Details

I. General information

NPI: 1891138152
Provider Name (Legal Business Name): ANTON BOGDANOV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2013
Last Update Date: 07/26/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E ECKERSON RD STE 160
NEW CITY NY
10956-7166
US

IV. Provider business mailing address

11 EVERGREEN PL
DEMAREST NJ
07627-2440
US

V. Phone/Fax

Practice location:
  • Phone: 845-634-8400
  • Fax:
Mailing address:
  • Phone: 917-603-0785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number288617
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: