1306037023 NPI number — RICHARD BODIAN, PT

Table of content: (NPI 1306037023)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306037023 NPI number — RICHARD BODIAN, PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICHARD BODIAN, PT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306037023
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/07/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4013 AVENUE U
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11234-5117
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-692-4100
Provider Business Mailing Address Fax Number:
718-692-0089

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1655 RICHMOND AVE
Provider Second Line Business Practice Location Address:
SUITE B102
Provider Business Practice Location Address City Name:
STATEN ISLAND
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10314-1570
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-370-3500
Provider Business Practice Location Address Fax Number:
718-370-9727
Provider Enumeration Date:
08/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BODIAN
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
718-692-4100

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  009469-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 013808-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: QMW1M1 . This is a "MEDICARE PROVIDER NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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