Provider Demographics
NPI:1598960577
Name:BOGIN, JEROME (DDS)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:
Last Name:BOGIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 COLD SPRING RD.
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791
Mailing Address - Country:US
Mailing Address - Phone:516-921-7444
Mailing Address - Fax:
Practice Address - Street 1:99 COLD SPRING RD.
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791
Practice Address - Country:US
Practice Address - Phone:516-921-7444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026833122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY026833OtherNY STATE LICENSE NUMBER