Provider Demographics
NPI:1912268848
Name:BOLGER, VANESSA LOUISE
Entity Type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:LOUISE
Last Name:BOLGER
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:VANESSA
Other - Middle Name:LOUISE
Other - Last Name:GRIECO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:825 W END AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-5349
Mailing Address - Country:US
Mailing Address - Phone:917-496-6050
Mailing Address - Fax:
Practice Address - Street 1:825 W END AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-5349
Practice Address - Country:US
Practice Address - Phone:917-496-6050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1343424174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist