Individual
MARK P BODACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 WEBSTER AVE, ATRIUM AT SFH, POUGHKEEPSIE, NY 12601-1361
(845) 483-5780
(845) 483-5787
Mailing address
1 WEBSTER AVE, ATRIUM AT SFH, POUGHKEEPSIE, NY 12601-1363
(845) 483-5780
(845) 483-5787
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
196328
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01849729
—
NY
Enumeration date
11/03/2005
Last updated
03/01/2022
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