Kirkwood Bodden Sr.

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

26NR16031700 Issued in NJ

Practice address

150 Bergen St
Newark, NJ 07103-2496

Phone

(973) 972-6000

NPI assigned

Sep 4, 2018

Last updated

Oct 23, 2019By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• The Kidney Group PA

  • Nephrology Physician
  • Newark, NJ
  • NPI 1326218546
  NPD (past)

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

{
    "created_epoch": "1536019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571788800000",
    "number": "1497237796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2106 ACKMEN CT",
            "city": "BRIDGEWATER",
            "state": "NJ",
            "postal_code": "088073558",
            "telephone_number": "908-393-4630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 BERGEN ST",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071032496",
            "telephone_number": "973-972-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BODDEN",
        "first_name": "KIRKWOOD",
        "name_prefix": "Mr.",
        "name_suffix": "Sr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-09-04",
        "last_updated": "2019-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NJ",
            "license": "26NR16031700",
            "primary": true
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NJ",
            "license": "26NJ00644200",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christine E. Boardingham, SLP
• Opoku Boateng
• Pooja Bobba
• Ivan Bobkov, MD
• Rebecca Bobrowski, CADC
• Stephanie A Bodnar, DMD
• Adenike Bodunde I, RBT
• Maximos Bogdady, DO
• Natasha Danielle Bohler
• Megan Bokert

• Nurse Practitioner in Newark, NJ
• Providers in Newark, NJ by specialty
• Nurse Practitioner in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2019; 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.