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General NPI Number Information
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NPI Number | 1962910307
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Entity Type | Individual
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Provider Name | CHRISTINA MARIE BOGNACKI NP
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Gender | Female
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Dates
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Enumeration Date | 01/19/2018
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Last Update Date | 01/19/2018
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Provider Practice Location Address
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Address Line | 600 COMMUNITY DR
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City | MANHASSET
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State | NY
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Zip | 11030-3802
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Country | US
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Telephone | 516-600-1162
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Fax |
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Provider Business Mailing Address
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Address Line | 28 SYLVIA LN
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City | NEW HYDE PARK
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State | NY
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Zip | 11040-1922
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Country | US
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Telephone | 516-652-3817
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 340958
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License Number State | NY
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