Provider Demographics
NPI:1407330608
Name:BOGOMOLNY, LARA (MS ED)
Entity Type:Individual
Prefix:MRS
First Name:LARA
Middle Name:
Last Name:BOGOMOLNY
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:MISS
Other - First Name:LARA
Other - Middle Name:
Other - Last Name:MORGAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:135 OCEANA DR E APT 1C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-6694
Mailing Address - Country:US
Mailing Address - Phone:917-654-1010
Mailing Address - Fax:
Practice Address - Street 1:135 OCEANA DR E APT 1C
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-6694
Practice Address - Country:US
Practice Address - Phone:917-654-1010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist