Provider Demographics
NPI:1083734800
Name:BUGIN, DAVID (HIS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:BUGIN
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 KASSON RD
Mailing Address - Street 2:
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-2233
Mailing Address - Country:US
Mailing Address - Phone:315-295-2153
Mailing Address - Fax:315-295-2154
Practice Address - Street 1:112 KASSON RD
Practice Address - Street 2:
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-2233
Practice Address - Country:US
Practice Address - Phone:315-295-2153
Practice Address - Fax:315-295-2154
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14000005215237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist