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General NPI Number Information
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NPI Number | 1912613910
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Entity Type | Individual
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Provider Name | BODHRAJ ACHARYA
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Gender | Male
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Dates
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Enumeration Date | 01/24/2023
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Last Update Date | 01/24/2023
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Provider Practice Location Address
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Address Line | 481 EDWARD H ROSS DR
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City | ELMWOOD PARK
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State | NJ
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Zip | 07407-3118
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Country | US
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Telephone | 314-415-1598
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Fax |
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Provider Business Mailing Address
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Address Line | 481 EDWARD H ROSS DR
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City | ELMWOOD PARK
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State | NJ
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Zip | 07407-3118
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Country | US
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Telephone | 314-415-1598
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0105X
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Taxonomy Name | Clinical Pathology/Laboratory Medicine Physician
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License Number | ACHAB1CLIN
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207ZH0000X
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Taxonomy Name | Hematology (Pathology) Physician
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License Number | ACHAB1HEMA
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License Number State | NY
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