Provider Demographics
NPI:1912269242
Name:ROTARU, BOGDAN (MS)
Entity Type:Individual
Prefix:MR
First Name:BOGDAN
Middle Name:
Last Name:ROTARU
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6214 83RD ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-1942
Mailing Address - Country:US
Mailing Address - Phone:646-942-7961
Mailing Address - Fax:
Practice Address - Street 1:649 39TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11232-3101
Practice Address - Country:US
Practice Address - Phone:718-851-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist