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General NPI Number Information
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NPI Number | 1568646982
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Entity Type | Organization
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Legal Business Name | SERGEY V. BOGDAN, MD PC
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Dates
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Enumeration Date | 12/20/2007
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Last Update Date | 01/14/2020
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Provider Practice Location Address
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Address Line | 8686 BAY PKWY STE M4
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City | BROOKLYN
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State | NY
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Zip | 11214-5193
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Country | US
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Telephone | 718-265-7700
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Fax | 718-265-7701
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Provider Business Mailing Address
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Address Line | 62 KEUNE CT
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City | STATEN ISLAND
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State | NY
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Zip | 10304-1431
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Country | US
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Telephone | 718-265-7700
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Fax | 718-265-7701
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | IRINA BOGDAN
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Credential |
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Telephone | 718-265-7700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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