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NPI Code Detail

MEDICARE: DR. BOHDAN GEORGE NYCHKA DDS

MEDICARE: DR. BOHDAN GEORGE NYCHKA DDS
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
11223G0001XGeneral Practice Dentistry027675NY

General Provider Information

NPI Number : 1578771960
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BOHDAN GEORGE NYCHKA DDS
Provider Business Mailing Address
First Line : 4602 30TH RD
Second Line :
City : ASTORIA
State : NY
Zip : 11103-1838
Country : US
Telephone Number : 718-777-5192
Fax Number :
Provider Business Practice Location Address
First Line : 68-80 SCHERMERHORN STREET
Second Line :
City : BROOKLYN
State : NY
Zip : 11201-5005
Country : US
Telephone Number : 718-858-7200
Fax Number : 718-522-1254
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/18/2007
Last Update Date : 07/08/2007

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