| Doctor Name: | DR. ADAM R BOGOMOL |
| NPI Number: | 1750366019 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 25MA07553500 |
| Business Practice Address: | 30 Prospect Ave Hackensack, NJ - 076011914 |
| Business Phone Number: | 2019962200 |
| Business Fax Number: | 2014892812 |
| Mailing Address: | 130 Kinderkamack Rd, Suite 200 RIVER EDGE |
| State: | NJ |
| Postal Code: | 076611939 |
| Phone Number: | 2014882660 |
| Fax Number: | 2014892812 |
| NPI Enumeration Date: | 12/09/2005 |
| NPI Last Update Date: | 03/27/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2085B0100X |
| License Number: | 25MA07553500 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NJ |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Radiology |
| Taxonomy Specialization: | Body Imaging |
| Taxonomy Definition: | A Radiology doctor of Osteopathy that specializes in Body Imaging. |