Provider Demographics
NPI:1306037023
Name:RICHARD BODIAN, PT
Entity Type:Organization
Organization Name:RICHARD BODIAN, PT
Other - Org Name:ONE ON ONE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:BODIAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-692-4100
Mailing Address - Street 1:4013 AVENUE U
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-5117
Mailing Address - Country:US
Mailing Address - Phone:718-692-4100
Mailing Address - Fax:718-692-0089
Practice Address - Street 1:1655 RICHMOND AVE
Practice Address - Street 2:SUITE B102
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-1570
Practice Address - Country:US
Practice Address - Phone:718-370-3500
Practice Address - Fax:718-370-9727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013808-1225100000X
NY009469-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQMW1M1OtherMEDICARE PROVIDER NUMBER