Basic Information
| Provider Information | |||||||||
| NPI: | 1689639940 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOGOSIAN | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | P | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5719 WIDEWATERS PKWY | ||||||||
| Address2: | |||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132141880 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3152513100 | ||||||||
| FaxNumber: | 3154499923 | ||||||||
| Practice Location | |||||||||
| Address1: | 5719 WIDEWATERS PKWY | ||||||||
| Address2: | |||||||||
| City: | DE WITT | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132141880 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3152513100 | ||||||||
| FaxNumber: | 3154499923 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2006 | ||||||||
| LastUpdateDate: | 04/05/2018 | ||||||||
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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 | 207X00000X | 158129 | NY | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XS0114X | 158129 | NY | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Adult Reconstructive Orthopaedic Surgery |
No ID Information.