Individual
KEVIN BOGUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NURSE PRACTITIONER
Contact information
Practice address
1 PENN PLZ, 8TH FLOOR, NEW YORK, NY 10119-0002
(646) 771-2206
(844) 290-6670
Mailing address
225 E 79TH ST APT 8D, NEW YORK, NY 10075-0827
(917) 804-7966
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
307208
NY
Other
Enumeration date
02/25/2015
Last updated
02/05/2016
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