1407008881 NPI number — DR. EMILY ROSE BOGDANOFF PHD

Table of content: DR. EMILY ROSE BOGDANOFF PHD (NPI 1407008881)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407008881 NPI number — DR. EMILY ROSE BOGDANOFF PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOGDANOFF
Provider First Name:
EMILY
Provider Middle Name:
ROSE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOGDANOFF
Provider Other First Name:
EMILY
Provider Other Middle Name:
ROSE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1407008881
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 JARRETT WHITE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TRIPLER ARMY MEDICAL CENTER
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96859-5001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-433-6418
Provider Business Mailing Address Fax Number:
808-433-4890

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 JARRETT WHITE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TRIPLER ARMY MEDICAL CENTER
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96859-5001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-433-6418
Provider Business Practice Location Address Fax Number:
808-433-4890
Provider Enumeration Date:
10/16/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PSY 18912 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)