Provider Demographics
NPI:1013948876
Name:BOGULSKI, JENNIFER ANN (PT DPT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:BOGULSKI
Suffix:
Gender:F
Credentials:PT DPT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT DPT
Mailing Address - Street 1:5268 BRIERCLIFF DR
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-3438
Mailing Address - Country:US
Mailing Address - Phone:716-491-3434
Mailing Address - Fax:716-649-4149
Practice Address - Street 1:5268 BRIERCLIFF DR
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-3438
Practice Address - Country:US
Practice Address - Phone:716-491-3434
Practice Address - Fax:716-649-4149
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027452225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA8357Medicare PIN