Provider Demographics
NPI:1518033687
Name:BODIAN, ADAM BEN (MD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:BEN
Last Name:BODIAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:11 GRACE AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021
Mailing Address - Country:US
Mailing Address - Phone:516-482-2882
Mailing Address - Fax:516-482-6039
Practice Address - Street 1:11 GRACE AVE
Practice Address - Street 2:SUITE 100 BODIAN DERMATOLOGY GROUP PC
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021
Practice Address - Country:US
Practice Address - Phone:516-482-2882
Practice Address - Fax:516-482-6039
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY176289207N00000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207N00000XAllopathic & Osteopathic PhysiciansDermatology
Not Answered207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
12234296OtherGREAT WEST
BA6289OtherATLANTIS HEALTH PLAN
NYAS1126OtherOXFORD
0737309000OtherAMERI HEALTH HMO ID
172689AOtherHEALTH FIRST
NYM2023POtherHIP
M2023POtherHIP
OC5423OtherHEALTHNET
19907OtherGHI
53H76OtherBLUE CROSS BLUE SHIELD
NYM2023POtherHIP
F53166Medicare UPIN