Monty Max Bodenheimer, MD

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

License

153049 Issued in NY

Practice address

3003 New Hyde Park Rd
Ste 406
New Hyde Park, NY 11042-1214

Phone

(516) 719-0102

Fax

(516) 358-5403

NPI assigned

Aug 30, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1280966400000",
    "number": "1013027671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3003 NEW HYDE PARK RD",
            "address_2": "STE 406",
            "city": "NEW HYDE PARK",
            "state": "NY",
            "postal_code": "110421214",
            "telephone_number": "516-719-0102",
            "fax_number": "516-358-5403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3003 NEW HYDE PARK RD",
            "address_2": "STE 406",
            "city": "NEW HYDE PARK",
            "state": "NY",
            "postal_code": "110421214",
            "telephone_number": "516-719-0102",
            "fax_number": "516-358-5403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BODENHEIMER",
        "first_name": "MONTY",
        "middle_name": "MAX",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2010-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NY",
            "license": "153049",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "919553",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bianca Ama Boafo
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• Brianna Boel, DO
• Stephanie Bogda
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• Cardiovascular Disease Physician in New Hyde Park, NY
• Providers in New Hyde Park, NY by specialty
• Cardiovascular Disease Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.