Provider Demographics
NPI:1992386916
Name:BODIONGAN, RODEL JASON (RN)
Entity Type:Individual
Prefix:MR
First Name:RODEL
Middle Name:JASON
Last Name:BODIONGAN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25504 87TH DR
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-1402
Mailing Address - Country:US
Mailing Address - Phone:516-263-6789
Mailing Address - Fax:
Practice Address - Street 1:25504 87TH DR
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-1402
Practice Address - Country:US
Practice Address - Phone:516-263-6789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY811067-01163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse