MEDICARE: RICHARD BODIAN, PT

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
1	225X00000X	Occupational Therapist
2	225100000X	Physical Therapist	013808-1	NY

General Provider Information

NPI Number	:	1790972941
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD BODIAN, PT

Provider Business Mailing Address
First Line	:	1655 RICHMOND AVE
Second Line	:	SUITE B102
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-1570
Country	:	US
Telephone Number	:	718-370-3500
Fax Number	:	718-370-9724

Provider Business Practice Location Address
First Line	:	1715 AVENUE T
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-3429
Country	:	US
Telephone Number	:	718-336-8206
Fax Number	:	718-336-8209

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	DIANE OFRIEL
Credential	:
Telephone Number	:	718-370-3500

Provider Enumeration Date	:	10/02/2007
Last Update Date	:	10/02/2007

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