Lorieta H Bogdan, M.D.

Individual provider Active NPI Pediatrics Physician · Spring Lake, NJ

NPI 1992962088 · NPPES record last updated May 17, 2008

Key facts

NPI
1992962088
Entity type
Individual (NPI type 1)
Primary specialty
Pediatrics Physician 208000000X
License
25MA06559900 (NJ)
Practice address
2220 1St Ave
Spring Lake, NJ 07762-1649
Phone
(732) 449-5653
NPI assigned
May 17, 2008
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
25MA06559900NJMDPediatrics Physician

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 25MA06559900 NJ Yes

Addresses

Primary practice location

2220 1St Ave
Spring Lake, NJ 07762-1649

Mailing address

2220 1St Ave
Spring Lake, NJ 07762-1649
Phone (732) 449-5653

Other providers in Spring Lake, NJ

All providers in Spring Lake, NJ · Pediatrics Physician in New Jersey

Sources for this page

Verify at the official NPI Registry.