Individual
DMITRY BOGOMOLNY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPA-C
Contact information
Practice address
635 W 165TH ST, NEW YORK, NY 10032-3724
(212) 305-3015
Mailing address
635 W 165TH ST, BOX 435, NEW YORK, NY 10032-3724
(212) 305-3015
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
013776-1
NY
Other
Enumeration date
02/06/2010
Last updated
04/25/2017
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