Provider Demographics
NPI:1164432068
Name:BODEKER, WILLIAM (NP)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:BODEKER
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 1ST AVE
Mailing Address - Street 2:12 WEST
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6402
Mailing Address - Country:US
Mailing Address - Phone:347-839-0533
Mailing Address - Fax:212-263-2357
Practice Address - Street 1:560 1ST AVE
Practice Address - Street 2:12 WEST
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6402
Practice Address - Country:US
Practice Address - Phone:347-839-0533
Practice Address - Fax:212-263-2357
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY334401363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily