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General NPI Number Information
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NPI Number | 1467464297
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Entity Type | Individual
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Provider Name | JOSEPH PETER BOGLIA MD
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Gender | Male
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Dates
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Enumeration Date | 08/12/2006
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Last Update Date | 01/31/2013
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Provider Practice Location Address
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Address Line | 200 BELLE TERRE ROAD STE 110
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City | PORT JEFFERSON
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State | NY
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Zip | 11777-1928
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Country | US
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Telephone | 631-476-1010
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Fax | 631-642-0105
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Provider Business Mailing Address
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Address Line | 200 BELLE TERRE ROAD STE 110
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City | PORT JEFFERSON
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State | NY
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Zip | 11777-1928
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Country | US
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Telephone | 631-476-1010
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Fax | 631-642-9805
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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 | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 219312
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License Number State | NY
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