Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | X2892 | NY |
NPI | 1003928169 |
---|---|
Provider Name | Dr. Richard J. Bogdanski |
First Address | Riverhead, NY 11901-2198 |
Second Address | Riverhead, NY 11901-2198 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |