Provider Demographics
NPI:1871674143
Name:BOGATY, MORTON
Entity Type:Individual
Prefix:
First Name:MORTON
Middle Name:
Last Name:BOGATY
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 1:5604 MARATHON PKWY
Mailing Address - Street 2:
Mailing Address - City:DOUGLASTON
Mailing Address - State:NY
Mailing Address - Zip Code:11362-2034
Mailing Address - Country:US
Mailing Address - Phone:718-423-3937
Mailing Address - Fax:718-423-3999
Practice Address - Street 1:5604 MARATHON PKWY
Practice Address - Street 2:
Practice Address - City:DOUGLASTON
Practice Address - State:NY
Practice Address - Zip Code:11362-2034
Practice Address - Country:US
Practice Address - Phone:718-423-3937
Practice Address - Fax:718-423-3999
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4284156FX1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5469690001Medicare ID - Type Unspecified