NPIMap

Organization Active NPI

Bodian Dermatology Group, P.C

  • Specialist
  • Great Neck, NY
National Provider Identifier
1659412104
Registry record updated May 29, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
176289 Issued in NY
Legal business name
BODIAN DERMATOLOGY GROUP, P.C
Practice address
11 Grace Ave
Suite 100
Great Neck, NY 11021-2417
Phone
(516) 482-2882
Fax
(516) 482-6039
NPI assigned
Feb 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 29, 2008

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

Authorized official

Name
Dr. Adam Ben Bodian II, MDNPI 1518033687
Title
President
Phone
(516) 482-2882

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 176289 NY Primary

Addresses

Primary practice location

11 Grace Ave
Suite 100
Great Neck, NY 11021-2417

Mailing address

11 Grace Ave
Suite 100
Great Neck, NY 11021-2417
Phone (516) 482-2882

Other identifiers 1

IdentifierTypeStateIssuer
CN7593OtherNYRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041013001168 NY Part B Supplier - Clinic/Group Practice 2062483316 Receives reassigned benefits from 8 practitioners
Practice locations: Great Neck, NY

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D0678450Bodian Dermatology Group PC11 Grace Avenue, Suite 100, Great Neck, NY 11021ComplianceOct 12, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1170979200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212019200000",
    "number": "1659412104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 GRACE AVE",
            "address_2": "SUITE 100",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110212417",
            "telephone_number": "516-482-2882",
            "fax_number": "516-482-6039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 GRACE AVE",
            "address_2": "SUITE 100",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110212417",
            "telephone_number": "516-482-2882",
            "fax_number": "516-482-6039"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BODIAN DERMATOLOGY GROUP, P.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-09",
        "last_updated": "2008-05-29",
        "status": "A",
        "authorized_official_last_name": "BODIAN",
        "authorized_official_first_name": "ADAM",
        "authorized_official_middle_name": "BEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "516-482-2882",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "II",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "NY",
            "license": "176289",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CN7593",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Great Neck, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.