Provider Demographics
NPI:1861705832
Name:BOGHRA, JALARK (DPT)
Entity type:Individual
Prefix:
First Name:JALARK
Middle Name:
Last Name:BOGHRA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 W 80TH ST
Mailing Address - Street 2:5TH FL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-7608
Mailing Address - Country:US
Mailing Address - Phone:212-874-1550
Mailing Address - Fax:212-874-1599
Practice Address - Street 1:1385 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:LARCHMONT
Practice Address - State:NY
Practice Address - Zip Code:10538-3933
Practice Address - Country:US
Practice Address - Phone:914-315-1800
Practice Address - Fax:914-315-1799
Is Sole Proprietor?:No
Enumeration Date:2010-07-20
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032722225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist