Provider Demographics
NPI:1578011391
Name:BOGOMILSKY, SHMUEL
Entity Type:Individual
Prefix:
First Name:SHMUEL
Middle Name:
Last Name:BOGOMILSKY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4014 CHASE AVE
Mailing Address - Street 2:SUITE 219
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-3452
Mailing Address - Country:US
Mailing Address - Phone:877-391-2751
Mailing Address - Fax:
Practice Address - Street 1:4014 CHASE AVE
Practice Address - Street 2:SUITE 219
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-3452
Practice Address - Country:US
Practice Address - Phone:877-391-2753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-21
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPED 224335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier