Provider Demographics
NPI:1063497295
Name:BODENHEIMER, HENRY CHARLES JR (MD)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:CHARLES
Last Name:BODENHEIMER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:160 WATER ST
Mailing Address - Street 2:20TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-4922
Mailing Address - Country:US
Mailing Address - Phone:212-256-3539
Mailing Address - Fax:
Practice Address - Street 1:10 UNION SQ E
Practice Address - Street 2:STE 2G, DEPT OF GASTROENTEROLOGY
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3314
Practice Address - Country:US
Practice Address - Phone:212-420-4015
Practice Address - Fax:212-844-5548
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY128274-1207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01284564Medicaid
NY01284564Medicaid
B13201Medicare UPIN