Provider Demographics
NPI:1942470794
Name:BOGLIOLI, JASON RAYMOND (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:RAYMOND
Last Name:BOGLIOLI
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 1:241 E MAIN ST UNIT 1D
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2917
Mailing Address - Country:US
Mailing Address - Phone:631-421-5885
Mailing Address - Fax:
Practice Address - Street 1:241 E MAIN ST UNIT 1D
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2917
Practice Address - Country:US
Practice Address - Phone:631-421-5885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-07
Last Update Date:2021-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225902207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine