Provider Demographics
NPI:1154199065
Name:BOVGIRYA, TATIANA (NP)
Entity type:Individual
Prefix:
First Name:TATIANA
Middle Name:
Last Name:BOVGIRYA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 PLAINFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-1900
Mailing Address - Country:US
Mailing Address - Phone:347-293-9079
Mailing Address - Fax:
Practice Address - Street 1:704 PLAINFIELD AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07922-1900
Practice Address - Country:US
Practice Address - Phone:347-293-9079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY311487363LA2200X
NJ26NJ14924400363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health