Healthcare Provider Details

I. General information

NPI: 1376561092
Provider Name (Legal Business Name): RICHARD H BODNER M. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 02/26/2021
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 1ST AVE DEPARTMENT OF OBSTETRICS AND GYNECOLOGY
NEW YORK NY
10016-6402
US

IV. Provider business mailing address

550 FIRST AVENUE DEPARTMENT OF OBSTETRICS AND GYNECOLOGY
NEW YORK NY
10016
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-6600
  • Fax: 212-263-8026
Mailing address:
  • Phone: 212-263-6600
  • Fax: 212-263-8026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MA03042600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number267804-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: