Provider Demographics
NPI:1427041847
Name:BOGLIOLI, LAUREN R (MD FACC FACP FCCP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:R
Last Name:BOGLIOLI
Suffix:
Gender:F
Credentials:MD FACC FACP FCCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:889 NORTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5303
Mailing Address - Country:US
Mailing Address - Phone:516-504-1280
Mailing Address - Fax:516-504-1290
Practice Address - Street 1:889 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5303
Practice Address - Country:US
Practice Address - Phone:516-504-1280
Practice Address - Fax:516-504-1290
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1904551207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
F93667Medicare UPIN