Provider Demographics
NPI:1881801298
Name:BOGACZ, EWA (OT)
Entity type:Individual
Prefix:MRS
First Name:EWA
Middle Name:
Last Name:BOGACZ
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 BATHURST AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH ARLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07031-6106
Mailing Address - Country:US
Mailing Address - Phone:201-955-2093
Mailing Address - Fax:
Practice Address - Street 1:12-15 SADDLE RIVER
Practice Address - Street 2:MAPLE GLEN CENTER
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410
Practice Address - Country:US
Practice Address - Phone:201-797-9522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003925-1273Y00000X
NJ46TR00570800314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No273Y00000XHospital UnitsRehabilitation Unit