Healthcare Provider Details

I. General information

NPI: 1306037023
Provider Name (Legal Business Name): RICHARD BODIAN, PT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2007
Last Update Date: 08/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1655 RICHMOND AVE SUITE B102
STATEN ISLAND NY
10314-1570
US

IV. Provider business mailing address

4013 AVENUE U
BROOKLYN NY
11234-5117
US

V. Phone/Fax

Practice location:
  • Phone: 718-370-3500
  • Fax: 718-370-9727
Mailing address:
  • Phone: 718-692-4100
  • Fax: 718-692-0089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number013808-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number009469-1
License Number StateNY

VIII. Authorized Official

Name: MR. RICHARD A BODIAN
Title or Position: OWNER
Credential: P.T.
Phone: 718-692-4100