Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | X003962 | NY |
NPI | 1316074198 |
---|---|
Provider Name | Dr. Chester L. Bogdan |
First Address | New York, NY 10019-1457 |
Second Address | New York, NY 10019-1457 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T71235 | (02) |