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General NPI Number Information
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NPI Number | 1174993752
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Entity Type | Organization
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Legal Business Name | V.D.BODAS, M.D.
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Dates
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Enumeration Date | 09/25/2015
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Last Update Date | 09/25/2015
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Provider Practice Location Address
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Address Line | 268 M. L. K. BLVD. BLDG. B 6TH FLOOR
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City | NEWARK
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State | NJ
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Zip | 07102
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Country | US
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Telephone | 973-623-0606
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Fax | 973-623-0626
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Provider Business Mailing Address
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Address Line | 268 M.L.K. BLVD. BUILDING B 6TH FLOOR
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City | NEWARK
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State | NJ
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Zip | 07102-0211
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Country | US
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Telephone | 973-623-0606
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Fax | 973-623-0626
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Authorized Official
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Title or Position | DR.
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Name | DR. VINAYAK D BODAS
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Credential | M.D.
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Telephone | 973-623-0606
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 25MA03353800
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License Number State | NJ
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