Provider Demographics
NPI:1306686811
Name:BOGANTZ, ROBERT LESLIE II
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:LESLIE
Last Name:BOGANTZ
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 BRANDYWINE DR APT I
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-1377
Mailing Address - Country:US
Mailing Address - Phone:740-263-1754
Mailing Address - Fax:
Practice Address - Street 1:3601 ROME CORNERS RD
Practice Address - Street 2:
Practice Address - City:GALENA
Practice Address - State:OH
Practice Address - Zip Code:43021-8503
Practice Address - Country:US
Practice Address - Phone:614-439-2795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker