Individual
DR. COURTNEY LAURA BOGART
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
165 W SHORE BLVD, NEWARK, NY 14513-1259
(315) 331-5059
Mailing address
165 W SHORE BLVD, NEWARK, NY 14513-1259
(315) 331-5059
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
65 006366
NY
213E00000X
Podiatrist
LIMITED LICENSE 1200
MA
213E00000X
Podiatrist
LPR00075
RI
Other
Enumeration date
02/25/2009
Last updated
11/01/2010
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