Provider Demographics
NPI:1457342123
Name:BODINE, STEVEN R (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:R
Last Name:BODINE
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 1:915 PALMER RD
Mailing Address - Street 2:
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-3304
Mailing Address - Country:US
Mailing Address - Phone:914-793-6900
Mailing Address - Fax:914-779-7810
Practice Address - Street 1:915 PALMER RD
Practice Address - Street 2:
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-3304
Practice Address - Country:US
Practice Address - Phone:914-793-6900
Practice Address - Fax:914-779-7810
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY142450-1146D00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00874458OtherWORKERS COMP
08595POtherHIP
B102520OtherLOCAL 825
NY00914645 03Medicaid
90291OtherAETNA
WS076OtherOXFORD
SB944OtherCONNECTICARE
10034072OtherCDPHP
NY43D271OtherBCBS
NY0066300OtherGHI
117098OtherAETNA US HEALTHCARE
SB372300OtherMVP
OD0856OtherHEALTHNET
NY00874458OtherWORKERS COMP
OD0856OtherHEALTHNET
NY00914645 03Medicaid