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General NPI Number Information
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NPI Number | 1649334319
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Entity Type | Individual
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Provider Name | BOGDAN MARK LANGNER PA-C
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Gender | Male
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 07/07/2008
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Provider Practice Location Address
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Address Line | 99 BEAUVOIR AVE
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City | SUMMIT
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State | NJ
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Zip | 07901-3533
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Country | US
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Telephone | 908-522-2172
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Fax | 908-522-4860
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Provider Business Mailing Address
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Address Line | 2358 LONGFELLOW AVE
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City | SCOTCH PLAINS
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State | NJ
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Zip | 07076-4520
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Country | US
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Telephone | 908-233-6223
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Fax | 908-233-2648
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 25MP00057700
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License Number State | NJ
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