Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 035800-1 | NY |
NPI | 1831283852 |
---|---|
Provider Name | Dr. Beth Boguslaw |
First Address | Bronx, NY 10457-5524 |
Second Address | Bronx, NY 10457-5524 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 08/07/2007 |