MEDICARE: SYDNEY BOGART MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	097175	NY

General Provider Information

NPI Number	:	1346212768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYDNEY BOGART MD

Provider Business Mailing Address
First Line	:	3761 87TH ST
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-7534
Country	:	US
Telephone Number	:	718-898-6700
Fax Number	:	718-898-1223

Provider Business Practice Location Address
First Line	:	3761 87TH ST
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-7534
Country	:	US
Telephone Number	:	718-898-6700
Fax Number	:	718-898-1223

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2006
Last Update Date	:	07/08/2007

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