Provider Demographics
NPI:1174993752
Name:V.D.BODAS, M.D.
Entity type:Organization
Organization Name:V.D.BODAS, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:VINAYAK
Authorized Official - Middle Name:D
Authorized Official - Last Name:BODAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-623-0606
Mailing Address - Street 1:268 M.L.K. BLVD.
Mailing Address - Street 2:BUILDING B 6TH FLOOR
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-0211
Mailing Address - Country:US
Mailing Address - Phone:973-623-0606
Mailing Address - Fax:973-623-0626
Practice Address - Street 1:268 M. L. K. BLVD.
Practice Address - Street 2:BLDG. B 6TH FLOOR
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102
Practice Address - Country:US
Practice Address - Phone:973-623-0606
Practice Address - Fax:973-623-0626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-25
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03353800261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1257404Medicaid