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General NPI Number Information
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NPI Number | 1477858074
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Entity Type | Organization
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Legal Business Name | DAVID S. BOGER, MD,PSYCHIATRY, PC
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Dates
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Enumeration Date | 01/13/2011
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Last Update Date | 01/13/2011
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Provider Practice Location Address
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Address Line | 138 W 25TH ST SUITE 622
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City | NEW YORK
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State | NY
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Zip | 10001-7405
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Country | US
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Telephone | 917-574-7541
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Fax |
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Provider Business Mailing Address
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Address Line | 138 W 25TH ST SUITE 622
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City | NEW YORK
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State | NY
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Zip | 10001-7405
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Country | US
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Telephone | 917-574-7541
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Fax |
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Authorized Official
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Title or Position | PRESIDENT OF CORPORATION
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Name | DR. DAVID SPROTT BOGER
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Credential | M.D.
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Telephone | 917-574-7441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 248496
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License Number State | NY
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