Provider Demographics
NPI:1982812756
Name:MAKARTCHUK, BOGDAN (DO, MD)
Entity type:Individual
Prefix:DR
First Name:BOGDAN
Middle Name:
Last Name:MAKARTCHUK
Suffix:
Gender:M
Credentials:DO, MD
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Mailing Address - Street 1:185 OLD COUNTRY RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2121
Mailing Address - Country:US
Mailing Address - Phone:631-298-4479
Mailing Address - Fax:631-591-3047
Practice Address - Street 1:332 W MONTAUK HWY
Practice Address - Street 2:STE 3
Practice Address - City:HAMPTON BAYS
Practice Address - State:NY
Practice Address - Zip Code:11946-3551
Practice Address - Country:US
Practice Address - Phone:631-728-0393
Practice Address - Fax:631-728-0394
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2017-02-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY239761208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400011675Medicare PIN
NYA400008912Medicare UPIN