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Individual

MR. KIRKWOOD BODDEN SR.

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
150 BERGEN ST, NEWARK, NJ 07103-2496
(973) 972-6000
Mailing address
2106 ACKMEN CT, BRIDGEWATER, NJ 08807-3558
(908) 393-4630

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
26NR16031700
NJ
363LA2200X
Adult Health Nurse Practitioner
26NJ00644200
NJ

Other

Enumeration date
09/04/2018
Last updated
10/23/2019
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