Healthcare Provider Details

I. General information

NPI: 1366499410
Provider Name (Legal Business Name): BOGNET MEDICAL ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 04/22/2020
Certification Date: 04/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 S CEDAR CREST BLVD SUITE #5
ALLENTOWN PA
18103-6207
US

IV. Provider business mailing address

1275 S CEDAR CREST BLVD SUITE #5
ALLENTOWN PA
18103-6207
US

V. Phone/Fax

Practice location:
  • Phone: 610-821-2820
  • Fax: 610-821-2859
Mailing address:
  • Phone: 610-821-2820
  • Fax: 610-821-2859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS 009228L
License Number StatePA

VIII. Authorized Official

Name: DR. JOSEPH CONRAD BOGNET
Title or Position: PRESIDENT
Credential: D.O.
Phone: 610-821-2820