NPIMap

Organization Active NPI

NJ - S Bogdan MD PC

  • Interventional Pain Medicine Physician
  • Old Bridge, NJ
National Provider Identifier
1508032673
Registry record updated Jan 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
Legal business name
NJ - S BOGDAN MD PC
Practice address
200 Perrine Rd Ste 224
Old Bridge, NJ 08857-2836
Phone
(732) 553-1214
Fax
(732) 553-1215
NPI assigned
May 7, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Sergey V Bogdan, MDNPI 1700894110
Title
Owner
Phone
(732) 553-1214

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2081P2900X
Interventional Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0014X Primary

Addresses

Primary practice location

200 Perrine Rd Ste 224
Old Bridge, NJ 08857-2836

Mailing address

62 Keune CT
Staten Island, NY 10304-1431
Phone (718) 265-7700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080617000008 NJ Part B Supplier - Clinic/Group Practice 3971674102 Receives reassigned benefits from 3 practitioners
Practice locations: Old Bridge, NJ

National Provider Directory

National Provider Directory

Locations

200 Perrine Rd
Ste 224
Old Bridge, NJ 08857
Phone (732) 553-1214

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1210118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579132800000",
    "number": "1508032673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "62 KEUNE CT",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103041431",
            "telephone_number": "718-265-7700",
            "fax_number": "718-265-7701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 PERRINE RD STE 224",
            "city": "OLD BRIDGE",
            "state": "NJ",
            "postal_code": "088572836",
            "telephone_number": "732-553-1214",
            "fax_number": "732-553-1215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NJ - S BOGDAN MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-07",
        "last_updated": "2020-01-16",
        "certification_date": "2020-01-16",
        "status": "A",
        "authorized_official_last_name": "BOGDAN",
        "authorized_official_first_name": "SERGEY",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "732-553-1214",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2081P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Old Bridge, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.