Individual
KISHANRAO BOGAVELLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
680 BROADWAY, PATERSON, NJ 07514-1422
(973) 977-6603
Mailing address
484 TEMPLE HILL RD, STE 102, NEW WINDSOR, NY 12553-5557
(845) 565-3700
(845) 565-3395
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MA44068
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3721205
—
NJ
Enumeration date
05/03/2007
Last updated
07/08/2007
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