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NPI Code Detail

MEDICARE: DR. ELLEN C BODNER DPT

MEDICARE: DR. ELLEN C BODNER DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistNYS4201NY

General Provider Information

NPI Number : 1285634725
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ELLEN C BODNER DPT
Provider Business Mailing Address
First Line : 20809 UNION TPKE
Second Line :
City : OAKLAND GARDENS
State : NY
Zip : 11364-3235
Country : US
Telephone Number : 718-479-6370
Fax Number : 718-464-0954
Provider Business Practice Location Address
First Line : 20809 UNION TPKE
Second Line :
City : OAKLAND GARDENS
State : NY
Zip : 11364-3235
Country : US
Telephone Number : 718-479-6370
Fax Number : 718-464-0954
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2005
Last Update Date : 09/23/2011

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