Provider Demographics
NPI:1912095977
Name:BOGACKI, DAVID F (PHD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:F
Last Name:BOGACKI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FEDERAL ST # 200
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1088
Mailing Address - Country:US
Mailing Address - Phone:856-356-4924
Mailing Address - Fax:
Practice Address - Street 1:3 COOPER PLZ
Practice Address - Street 2:SUITE 307
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1438
Practice Address - Country:US
Practice Address - Phone:856-342-2328
Practice Address - Fax:856-541-6137
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSI001777002084P0802X
NJ35SI00177700103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
0101145000OtherAMERIHEALTH HMO, KEYSTONE, IBC
001664070OtherAMERIHEALTH PPO
010003754OtherAMERICHOICE
293304000OtherMAGELLAN
620004717OtherRR MEDICARE
1127825OtherHORIZON NJ HEALTH
4528678OtherAETNA
NJ1339303Medicaid
24702OtherUNIVERSITY HEALTHPLAN
24702OtherUNIVERSITY HEALTHPLAN
NJ441341 AVUMedicare PIN