MEDICARE: MONIQUE BOGNI CNC, CHHC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	133N00000X	Nutritionist	CA
2	133NN1002X	Nutrition Education Nutritionist
3	171400000X	Health & Wellness Coach	NY

General Provider Information

NPI Number	:	1710611355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONIQUE BOGNI CNC, CHHC

Provider Business Mailing Address
First Line	:	188 ECKFORD ST APT 4
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11222-3247
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	188 ECKFORD ST APT 4
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11222-3247
Country	:	US
Telephone Number	:	925-989-9839
Fax Number	:

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

Provider Enumeration Date	:	07/11/2022
Last Update Date	:	07/11/2022

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