Provider Demographics
NPI:1184951592
Name:BOURGOING, PHILIPPE (OTD)
Entity type:Individual
Prefix:DR
First Name:PHILIPPE
Middle Name:
Last Name:BOURGOING
Suffix:
Gender:M
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 AMSTERDAM AVE APT 10G
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-5136
Mailing Address - Country:US
Mailing Address - Phone:917-478-3152
Mailing Address - Fax:
Practice Address - Street 1:850 AMSTERDAM AVE APT 10G
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-5136
Practice Address - Country:US
Practice Address - Phone:917-478-3152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009336-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist