Dmitri Bougakov, PH.D.

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

68 017107 Issued in NY

Practice address

315 W 57TH St
Suite 401
New York, NY 10019-3158

Phone

(646) 496-8963

NPI assigned

Apr 10, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1227571200000",
    "number": "1851414031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 W 57TH ST",
            "address_2": "SUITE 401",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100193158",
            "telephone_number": "646-496-8963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 W 57TH ST",
            "address_2": "SUITE 401",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100193158",
            "telephone_number": "646-496-8963"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUGAKOV",
        "first_name": "DMITRI",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-10",
        "last_updated": "2008-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "NY",
            "license": "68 017107",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02969217",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nathan A Boucher, PA
• Thomas Boucher, MD
• Brianna Bouchez, FNP-C
• Nicole Boucicaut, PA-C
• Tyson Jude Boudreaux, MD
• Mohamed A Bouhara, M.D
• Ismail Bouhout, MD, MSC
• Caroline Emilie Bouillon, PA-C
• Meriem Boukadoum
• Farid Boulad, MD

• Clinical Neuropsychologist in New York, NY
• Providers in New York, NY by specialty
• Clinical Neuropsychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.