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General NPI Number Information
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NPI Number | 1306037023
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Entity Type | Organization
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Legal Business Name | RICHARD BODIAN, PT
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Dates
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Enumeration Date | 08/07/2007
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Last Update Date | 08/07/2007
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Provider Practice Location Address
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Address Line | 1655 RICHMOND AVE SUITE B102
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City | STATEN ISLAND
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State | NY
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Zip | 10314-1570
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Country | US
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Telephone | 718-370-3500
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Fax | 718-370-9727
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Provider Business Mailing Address
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Address Line | 4013 AVENUE U
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City | BROOKLYN
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State | NY
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Zip | 11234-5117
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Country | US
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Telephone | 718-692-4100
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Fax | 718-692-0089
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Authorized Official
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Title or Position | OWNER
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Name | MR. RICHARD A BODIAN
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Credential | P.T.
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Telephone | 718-692-4100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 009469-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 013808-1
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License Number State | NY
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