Provider Demographics
NPI:1942394143
Name:BODENSTEIN, LAWRENCE (MD,PHD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:
Last Name:BODENSTEIN
Suffix:
Gender:M
Credentials:MD,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FIRST AVE AT 16TH ST
Mailing Address - Street 2:BAIRD HALL SUITE 15BH51
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003
Mailing Address - Country:US
Mailing Address - Phone:212-844-8840
Mailing Address - Fax:212-819-6948
Practice Address - Street 1:10 UNION SQ E
Practice Address - Street 2:SUITE 2L
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3314
Practice Address - Country:US
Practice Address - Phone:212-844-8840
Practice Address - Fax:212-819-6948
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1928122086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1506918Medicaid