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General NPI Number Information
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NPI Number | 1407254949
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Entity Type | Individual
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Provider Name | AMY JEAN BOGART
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Gender | Female
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Dates
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Enumeration Date | 12/16/2014
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Last Update Date | 12/16/2014
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Provider Practice Location Address
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Address Line | 1465 ROUTE 31 THIRD FLOOR
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City | ANNANDALE
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State | NJ
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Zip | 08801-3129
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Country | US
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Telephone | 908-328-3300
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Fax | 903-328-3268
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Provider Business Mailing Address
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Address Line | 1465 ROUTE 31 THIRD FLOOR
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City | ANNANDALE
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State | NJ
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Zip | 08801-3129
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Country | US
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Telephone | 908-328-3300
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Fax | 903-328-3268
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40QA00451800
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License Number State | NJ
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