Healthcare Provider Details

I. General information

NPI: 1487444774
Provider Name (Legal Business Name): SCOTT BOGUMIL RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2025
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1565 LONG POND RD
ROCHESTER NY
14626-4168
US

IV. Provider business mailing address

1565 LONG POND RD
ROCHESTER NY
14626-4168
US

V. Phone/Fax

Practice location:
  • Phone: 585-723-7723
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number695746
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: