Provider Demographics
NPI:1932995933
Name:BUGOW, DAN (CDRS)
Entity type:Individual
Prefix:
First Name:DAN
Middle Name:
Last Name:BUGOW
Suffix:
Gender:M
Credentials:CDRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 MIDDLE RD
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-5875
Mailing Address - Country:US
Mailing Address - Phone:315-592-1561
Mailing Address - Fax:315-889-8812
Practice Address - Street 1:812 STATE FAIR BLVD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13209-1307
Practice Address - Country:US
Practice Address - Phone:315-341-8811
Practice Address - Fax:315-889-8812
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist