Provider Demographics
NPI:1649334319
Name:LANGNER, BOGDAN MARK (PA-C)
Entity type:Individual
Prefix:MR
First Name:BOGDAN
Middle Name:MARK
Last Name:LANGNER
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:2358 LONGFELLOW AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTCH PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07076-4520
Mailing Address - Country:US
Mailing Address - Phone:908-233-6223
Mailing Address - Fax:908-233-2648
Practice Address - Street 1:99 BEAUVOIR AVE
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-3533
Practice Address - Country:US
Practice Address - Phone:908-522-2172
Practice Address - Fax:908-522-4860
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2008-07-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MP00057700363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical