Provider Demographics
NPI:1679054225
Name:BOGDON, JAIMEE (MSN, FNP-C)
Entity Type:Individual
Prefix:
First Name:JAIMEE
Middle Name:
Last Name:BOGDON
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3102 ALICIA DR
Mailing Address - Street 2:
Mailing Address - City:WALL TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-4404
Mailing Address - Country:US
Mailing Address - Phone:908-489-4740
Mailing Address - Fax:
Practice Address - Street 1:175 PATTERSON AVE
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4141
Practice Address - Country:US
Practice Address - Phone:732-747-4600
Practice Address - Fax:732-219-1968
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00840700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine