Provider Demographics
NPI:1396708277
Name:KRGIN, BOJANA (MD)
Entity type:Individual
Prefix:
First Name:BOJANA
Middle Name:
Last Name:KRGIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2475 SAINT RAYMONDS AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-3124
Mailing Address - Country:US
Mailing Address - Phone:718-430-4384
Mailing Address - Fax:718-430-7337
Practice Address - Street 1:2475 SAINT RAYMONDS AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-3124
Practice Address - Country:US
Practice Address - Phone:718-430-4384
Practice Address - Fax:718-430-7337
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY185303207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01839990Medicaid
NY52R41OtherBC/BS
NY52R41OtherBC/BS
NYF42528Medicare UPIN