Provider Demographics
NPI:1891732723
Name:FELIX BOGOMOLNY
Entity Type:Organization
Organization Name:FELIX BOGOMOLNY
Other - Org Name:ORTHO MEDICAL SUPPLY COMPANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FELIX
Authorized Official - Middle Name:
Authorized Official - Last Name:BOGOMOLNY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-508-1100
Mailing Address - Street 1:12729 VENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-2430
Mailing Address - Country:US
Mailing Address - Phone:818-508-1100
Mailing Address - Fax:818-508-1455
Practice Address - Street 1:12729 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-2430
Practice Address - Country:US
Practice Address - Phone:818-508-1100
Practice Address - Fax:818-508-1455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103867332B00000X
CA18010332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4031100001Medicare ID - Type Unspecified