Provider Demographics
NPI:1417006743
Name:BOLGER, DENNIS (CRNA)
Entity Type:Individual
Prefix:MS
First Name:DENNIS
Middle Name:
Last Name:BOLGER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 GRASSLANDS RD
Mailing Address - Street 2:ROOM 2395 MACY PAVILLION WMC
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595-1646
Mailing Address - Country:US
Mailing Address - Phone:914-347-0380
Mailing Address - Fax:914-347-0390
Practice Address - Street 1:95 GRASSLANDS RD
Practice Address - Street 2:ROOM 2395 MACY PAVILLION WMC
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1646
Practice Address - Country:US
Practice Address - Phone:914-347-0380
Practice Address - Fax:914-347-0390
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4744401367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR5C931Medicare ID - Type Unspecified