Basic Information
| Provider Information | |||||||||
| NPI: | 1912095977 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOGACKI | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | F | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 FEDERAL ST # 200 | ||||||||
| Address2: | |||||||||
| City: | CAMDEN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 081031088 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8563564924 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3 COOPER PLZ | ||||||||
| Address2: | SUITE 307 | ||||||||
| City: | CAMDEN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 081031438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8563422328 | ||||||||
| FaxNumber: | 8565416137 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2006 | ||||||||
| LastUpdateDate: | 11/20/2019 | ||||||||
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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 | 2084P0802X | SI00177700 | NJ | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Psychiatry | 103T00000X | 35SI00177700 | NJ | Y | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | 0101145000 | 01 | AMERIHEALTH HMO, KEYSTONE, IBC | OTHER | 001664070 | 01 | AMERIHEALTH PPO | OTHER | 010003754 | 01 | AMERICHOICE | OTHER | 293304000 | 01 | MAGELLAN | OTHER | 620004717 | 01 | RR MEDICARE | OTHER | 1127825 | 01 | HORIZON NJ HEALTH | OTHER | 4528678 | 01 | AETNA | OTHER | 1339303 | 05 | NJ | MEDICAID | 24702 | 01 | UNIVERSITY HEALTHPLAN | OTHER |