Provider Demographics
NPI:1356415913
Name:VINAYAK D. BODAS
Entity type:Organization
Organization Name:VINAYAK D. BODAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC NEUROLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VINAYAK
Authorized Official - Middle Name:D
Authorized Official - Last Name:BODAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-623-0606
Mailing Address - Street 1:268 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-2011
Mailing Address - Country:US
Mailing Address - Phone:973-623-0606
Mailing Address - Fax:
Practice Address - Street 1:268 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-2011
Practice Address - Country:US
Practice Address - Phone:973-623-0606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1257404-01Medicaid
NJ1257404-01Medicaid