Provider Demographics
NPI:1740482397
Name:VOGEL, BRUCE SANDOR (PHD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:SANDOR
Last Name:VOGEL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:993 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0809
Mailing Address - Country:US
Mailing Address - Phone:212-734-8343
Mailing Address - Fax:
Practice Address - Street 1:993 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0809
Practice Address - Country:US
Practice Address - Phone:212-734-8343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3606103TC0700X
MA8143103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW06413OtherBCBSMA
NY146241OtherVALUE OPTIONS