Basic Information
| Provider Information | |||||||||
| NPI: | 1467464297 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOGLIA | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | PETER | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 BELLE TERRE ROAD | ||||||||
| Address2: | STE 110 | ||||||||
| City: | PORT JEFFERSON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117771928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314761010 | ||||||||
| FaxNumber: | 6316429805 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 BELLE TERRE ROAD | ||||||||
| Address2: | STE 110 | ||||||||
| City: | PORT JEFFERSON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117771928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314761010 | ||||||||
| FaxNumber: | 6316420105 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2006 | ||||||||
| LastUpdateDate: | 01/31/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | 219312 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | PRV0004554 | 01 | NY | MONTEFIORE | OTHER | 7X2132 | 01 | NY | EMPIRE BCBS | OTHER | 7293637 | 01 | NY | AETNA | OTHER | 2120125 | 01 | NY | VYTRA | OTHER | P00161349 | 01 | NY | RAILROAD MEDICARE | OTHER |