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General NPI Number Information
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NPI Number | 1043441777
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Entity Type | Organization
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Legal Business Name | BODIAN MEDICAL SERVICES OF FOREST HILLS PC
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Dates
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Enumeration Date | 07/29/2009
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Last Update Date | 07/29/2009
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Provider Practice Location Address
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Address Line | 10420 QUEENS BLVD SUITE 1D
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City | FOREST HILLS
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State | NY
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Zip | 11375-3629
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Country | US
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Telephone | 718-459-2121
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Fax |
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Provider Business Mailing Address
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Address Line | 11 GRACE AVE SUITE 100
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City | GREAT NECK
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State | NY
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Zip | 11021-2417
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Country | US
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Telephone | 516-482-2882
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Fax | 516-482-6039
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ADAM B. BODIAN
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Credential | MD
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Telephone | 516-482-2882
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 176289
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License Number State | NY
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