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General NPI Number Information
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NPI Number | 1023490919
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Entity Type | Organization
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Legal Business Name | DR. STANLEY BOGUSZ, DPM, LLC
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Dates
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Enumeration Date | 06/26/2015
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Last Update Date | 03/22/2016
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Provider Practice Location Address
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Address Line | 938 POWELL AVE
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City | ERIE
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State | PA
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Zip | 16505-3439
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Country | US
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Telephone | 814-833-8331
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Fax | 814-833-8338
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Provider Business Mailing Address
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Address Line | 938 POWELL AVE
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City | ERIE
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State | PA
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Zip | 16505-3439
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Country | US
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Telephone | 814-833-8331
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Fax | 814-833-8338
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Authorized Official
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Title or Position | OWNER
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Name | DR. STANLEY BOGUSZ
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Credential | D.P.M.
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Telephone | 814-833-8331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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