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General NPI Number Information
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NPI Number | 1790066223
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Entity Type | Individual
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Provider Name | JACK BOGART JR. CRNP
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Gender | Male
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Dates
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Enumeration Date | 08/29/2011
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Last Update Date | 11/28/2025
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Provider Practice Location Address
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Address Line | 3 HOSPITAL DR STE 206
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City | LEWISBURG
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State | PA
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Zip | 17837-9394
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Country | US
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Telephone | 570-524-4141
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Fax |
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Provider Business Mailing Address
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Address Line | 601 MEMORY LN
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City | YORK
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State | PA
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Zip | 17402-2231
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Country | US
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Telephone | 717-851-1405
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Fax |
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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 | 363LC0200X
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Taxonomy Name | Critical Care Medicine Nurse Practitioner
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License Number | SP011577
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | SP011577
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License Number State | PA
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