Basic Information
| Provider Information | |||||||||
| NPI: | 1417095118 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BODNAR | ||||||||
| FirstName: | ALEKSANDER | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 930 N WOOD AVE | ||||||||
| Address2: | |||||||||
| City: | LINDEN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070364040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9089257400 | ||||||||
| FaxNumber: | 9089257474 | ||||||||
| Practice Location | |||||||||
| Address1: | 930 N WOOD AVE | ||||||||
| Address2: | |||||||||
| City: | LINDEN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070364040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9089257400 | ||||||||
| FaxNumber: | 9089257474 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 25MA06116600 | NJ | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 6306608 | 05 | NJ | MEDICAID |