MR. GARY CHARLES BODENBURG (NPI# 1255693065) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255693065 |
| Entity Type | Individual |
| Full Name | MR. GARY CHARLES BODENBURG |
| Credential | MSED |
| Practice Address |
300 Garden City Plaza 350 Garden City NY 11530 |
| Mailing Address |
23 Ruland Rd Selden NY 11784-2301 |
| Practice Telephone | 5167479030 |
| Practice Fax Number | 5163939116 |
| Mailing Telephone | 6318464810 |
| Enumeration Date | 2012-06-08 |
| Last Update Date | 2012-06-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | 1748234 | NY | Other Service Providers |
| Street Address |
300 GARDEN CITY PLAZA 350 |
| City | GARDEN CITY |
| State | NY |
| Zip Code | 11530 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386606655 | Peter Harry Koumas | Dentist | 300 Garden City Plaza, Ste 230, Garden City, NY 11530 | 2006-04-04 |
| 1831741743 | Jennifer A Loose | Occupational Therapist | 300 Garden City Plaza, Suite 350, Garden City, NY 11530 | 2019-07-10 |
| 1295234896 | Molly Male Drake | Specialist | 300 Garden City Plaza, Garden City, NY 11530 | 2018-02-08 |
| 1629406921 | Kristi Bocchieri | Behavioral Analyst | 300 Garden City Plaza, Garden City, NY 11530 | 2013-10-23 |
| 1629313325 | Cara Mia Barca | Case Manager/Care Coordinator | 300 Garden City Plaza, Garden City, NY 11756 | 2012-12-06 |
| 1811241862 | Mandy A Kelly | Specialist | 300 Garden City Plaza, Suite 350, Garden City, NY 11530 | 2012-10-30 |
| 1487916052 | Angela Farinacci | Specialist | 300 Garden City Plaza, Garden City, NY 11530 | 2012-06-11 |
| 1326300070 | Tara Kelly | Specialist | 300 Garden City Plaza, Garden City, NY 11530 | 2012-06-08 |
| 1235491960 | Kim Marie Fitzgerald | Specialist | 300 Garden City Plaza, Garden City, NY 11530 | 2012-06-08 |
| 1750651709 | Jaime Lynn Webber | Behavioral Analyst | 300 Garden City Plaza, Suite 350, Garden City, NY 11530 | 2012-01-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144850207 | Ellen Jay Palacio Mabatid | Physical Therapist | 66 New Hyde Park, Garden City, NY 11530 | 2020-01-16 |
| 1255991022 | Rubin Anesthesia Pain Management, Pllc | Anesthesiology | 1103 Stewart Avenue, Suite 300, Garden City, NY 11530 | 2019-06-14 |
| 1144793720 | Jack Doby Garden City, LLC | Eyewear Supplier (Equipment, not the service) | Jack Doby Garden City, LLC, 928 Old Country Road, Garden City, NY 11530 | 2019-01-07 |
| 1386135051 | Granger & Sahasra | Dentist | 1103 Stewart Avenue Suite 104, Garden City, NY 11530 | 2018-05-29 |
| 1598262537 | Suzanne P. Reid-bradshaw | Specialist | Kidz Therapy, 300 Garden City Plaza, Garden City, NY 11530 | 2018-04-06 |
| 1972021129 | Nicole Maria Gaudino | Nurse Practitioner | One South Avenue, Waldo Hall, Garden City, NY 11530 | 2017-09-07 |
| 1619495645 | Christine Scheppa | Registered Nurse | 225 Brompton Rd South, Garden City South, NY 11530 | 2017-08-30 |
| 1699290981 | Deborah Ann Pontosky | Registered Nurse | 104 Fifth Street, Garden City, NY 11530 | 2017-08-08 |
| 1932648748 | Tahmina Jahir | Student in an Organized Health Care Education/Training Program | 15 Hilton Ave, Garden City, NY 11530 | 2017-02-14 |
| 1598209173 | Dino Michelli | Specialist | 300 Garden City Plaza, Ste 350, Kidz Therapy/ Gayle E. Kligman Therapeutic Resources, Garden City, NY 11530 | 2016-12-15 |
| Find all providers in zip 11530 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154936797 | Catey Lynn Weiner | Specialist | 1208 Mitchel Field Way, Garden City, NY 11530-5063 | 2020-09-10 |
| 1164040705 | New Horizons Gastroenterology, Pllc | Specialist | 585 Stewart Ave Ste 412, Garden City, NY 11530-4701 | 2020-07-09 |
| 1497212443 | Albert William Heuser Iv | Specialist | 81 Garden St, Garden City, NY 11530-6506 | 2019-02-26 |
| 1881165785 | Michael Biancaniello | Specialist | 114 Hayes St, Garden City, NY 11530-2518 | 2018-12-17 |
| 1710465893 | Michael E Wess | Specialist | 34 Wellington Rd, Garden City, NY 11530-4148 | 2018-08-01 |
| 1114403417 | Kerin Sanford | Specialist | 173 Brixton Rd, Garden City, NY 11530-1323 | 2018-07-19 |
| 1598262537 | Suzanne P. Reid-bradshaw | Specialist | Kidz Therapy, 300 Garden City Plaza, Garden City, NY 11530 | 2018-04-06 |
| 1013419936 | Lorelyn Fitzgerald | Specialist | 18 Saint James St S, Garden City, NY 11530-6219 | 2018-03-07 |
| 1922512995 | Michelle Lynne Gould | Specialist | 300 Garden City Plz Ste 300, Garden City, NY 11530-3331 | 2017-11-28 |
| 1386158095 | George Andrew Reichenbach I | Specialist | 97 Roosevelt St, Garden City, NY 11530-3938 | 2017-11-17 |
| Find all providers in GARDEN CITY | ||||
| City | GARDEN CITY |
| Zip Code | 11530 |
Please comment or provide details below to improve the information on MR. GARY CHARLES BODENBURG.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.