Provider Demographics
NPI:1609171016
Name:BOGER, DAVID SPROTT (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:SPROTT
Last Name:BOGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 W 25TH ST
Mailing Address - Street 2:SUITE 622
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-7405
Mailing Address - Country:US
Mailing Address - Phone:917-574-7541
Mailing Address - Fax:
Practice Address - Street 1:138 W 25TH ST
Practice Address - Street 2:SUITE 622
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-7405
Practice Address - Country:US
Practice Address - Phone:917-574-7541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-14
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2484962084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry