Provider Demographics
NPI:1649470709
Name:BOG HEALTH SUPPLIES CO.
Entity type:Organization
Organization Name:BOG HEALTH SUPPLIES CO.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:RUZIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-703-2031
Mailing Address - Street 1:1115 NEWKIRK AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-1417
Mailing Address - Country:US
Mailing Address - Phone:718-703-2031
Mailing Address - Fax:718-703-2086
Practice Address - Street 1:1115 NEWKIRK AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-1417
Practice Address - Country:US
Practice Address - Phone:718-703-2031
Practice Address - Fax:718-703-2086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRFO02272332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02256128Medicaid
NY02256128Medicaid