Provider Demographics
NPI:1376561092
Name:BODNER, RICHARD H (M D)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:H
Last Name:BODNER
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 FIRST AVENUE
Mailing Address - Street 2:DEPARTMENT OF OBSTETRICS AND GYNECOLOGY
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016
Mailing Address - Country:US
Mailing Address - Phone:212-263-6600
Mailing Address - Fax:212-263-8026
Practice Address - Street 1:550 1ST AVE
Practice Address - Street 2:DEPARTMENT OF OBSTETRICS AND GYNECOLOGY
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6402
Practice Address - Country:US
Practice Address - Phone:212-263-6600
Practice Address - Fax:212-263-8026
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03042600207V00000X
NY267804-1207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1075306Medicaid
NJ1075306Medicaid