Provider Demographics
NPI:1104045798
Name:BOGOTA LABORATORIES, INC.
Entity Type:Organization
Organization Name:BOGOTA LABORATORIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GEHRICKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-652-5551
Mailing Address - Street 1:PO BOX 724
Mailing Address - Street 2:
Mailing Address - City:OCEANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08231-0724
Mailing Address - Country:US
Mailing Address - Phone:609-652-5551
Mailing Address - Fax:609-652-5554
Practice Address - Street 1:634 E LOST PINE WAY RD
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-9694
Practice Address - Country:US
Practice Address - Phone:609-652-5551
Practice Address - Fax:609-652-5554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8721408Medicaid
NJ3868310001Medicare NSC