Provider Demographics
NPI:1023313343
Name:BOGARD, DENISE
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:BOGARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:
Other - Last Name:RUSNAK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:65 MILLER BLVD
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-3528
Mailing Address - Country:US
Mailing Address - Phone:516-864-6806
Mailing Address - Fax:516-364-2450
Practice Address - Street 1:148 GARDINERS AVE
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-3707
Practice Address - Country:US
Practice Address - Phone:516-864-6806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004072-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist