1275675001 NPI number — MS. KAREN ELISE BOGERMAN-BOLLE ACNP

Table of content: KATHERINE D'AUNNO LCSW (NPI 1831762418)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275675001 NPI number — MS. KAREN ELISE BOGERMAN-BOLLE ACNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOGERMAN-BOLLE
Provider First Name:
KAREN
Provider Middle Name:
ELISE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
ACNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MADISON
Provider Other First Name:
KAREN
Provider Other Middle Name:
ELISE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1275675001
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 PIPERS GLN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST NYACK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10994-2114
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-608-7559
Provider Business Mailing Address Fax Number:
845-215-5549

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 PIPERS GLN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST NYACK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10994-2114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-608-7559
Provider Business Practice Location Address Fax Number:
845-215-5549
Provider Enumeration Date:
02/12/2007

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: 363LA2100X , with the licence number:  F302046 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: F302046 . This is a "MEDICAL LICENSE #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".