MEDICARE: DR. SERGEY V BOGDAN M.D.

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	208VP0014X	Interventional Pain Medicine Physician	222300	NY
2	208100000X	Physical Medicine & Rehabilitation Physician	222300	NY
3	208100000X	Physical Medicine & Rehabilitation Physician	25MA0719390	NJ
4	208VP0014X	Interventional Pain Medicine Physician	25MA0719390	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700894110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SERGEY V BOGDAN M.D.

Provider Business Mailing Address
First Line	:	62 KEUNE CT
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10304-1431
Country	:	US
Telephone Number	:	718-265-7700
Fax Number	:	718-265-7701

Provider Business Practice Location Address
First Line	:	8686 BAY PKWY STE M4
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-5193
Country	:	US
Telephone Number	:	718-265-7700
Fax Number	:	718-265-7701

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

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	03/17/2018

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