Provider Demographics
NPI:1619066339
Name:BODOFSKY, ELLIOT B (MD)
Entity Type:Individual
Prefix:
First Name:ELLIOT
Middle Name:B
Last Name:BODOFSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FEDERAL ST # 100
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1088
Mailing Address - Country:US
Mailing Address - Phone:856-356-4924
Mailing Address - Fax:856-356-4793
Practice Address - Street 1:1 COOPER PLZ
Practice Address - Street 2:SUITE 550
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1461
Practice Address - Country:US
Practice Address - Phone:856-342-2040
Practice Address - Fax:856-968-8311
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA48588208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
0457494000OtherAMERIHEALTH HMO, KEYSTONE, IBC
1066071OtherHORIZON NJ HEALTH
3K7746OtherHEALTHNET
627749OtherAMERIHEALTH PPO
2080640OtherUNITED HEALTHCARE
250010343OtherRR MEDICARE
463646OtherAETNA
NJ6115403Medicaid
25032OtherUNIVERSITY HEALTHPLAN
CA0000263OtherAMERICHOICE
8058165OtherCIGNA
P561499OtherOXFORD HEALTHPLAN
0457494000OtherAMERIHEALTH HMO, KEYSTONE, IBC
E57239Medicare UPIN