Provider Demographics
NPI:1639616675
Name:BOGATIN, DIANA SOFIA
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:SOFIA
Last Name:BOGATIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1997 OCEAN AVE
Mailing Address - Street 2:APT. 2A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-7385
Mailing Address - Country:US
Mailing Address - Phone:646-821-5230
Mailing Address - Fax:
Practice Address - Street 1:1997 OCEAN AVE
Practice Address - Street 2:APT. 2A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-7385
Practice Address - Country:US
Practice Address - Phone:646-821-5230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-29
Last Update Date:2017-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist