Provider Demographics
NPI:1366704009
Name:WILLIAM BOLLENGIER MD, PC
Entity type:Organization
Organization Name:WILLIAM BOLLENGIER MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLLENGIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-454-9955
Mailing Address - Street 1:29 FOX ST
Mailing Address - Street 2:SUITE101
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-4714
Mailing Address - Country:US
Mailing Address - Phone:845-454-9955
Mailing Address - Fax:845-454-9949
Practice Address - Street 1:29 FOX ST
Practice Address - Street 2:SUITE101
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-4714
Practice Address - Country:US
Practice Address - Phone:845-454-9955
Practice Address - Fax:845-454-9949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A100000340Medicare UPIN