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Individual

DR. ANI A BODOUTCHIAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
120 ROUTE 109, WEST BABYLON, NY 11704-6210
(631) 422-3636
(631) 422-2788
Mailing address
120 ROUTE 109, WEST BABYLON, NY 11704-6210
(631) 422-3636
(631) 422-2788

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
210217
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
01944994
NY
01
080149262
RAILROAD MEDICARE
NY
01
102407
AETNA US HEALTHCARE
NY
01
104807
VYTRA
NY
01
1317543
CIGNA
NY
01
2C5668
HEALTH NET
NY
01
5443340002
MEDICARE DME
NY
01
5998961
GHI
NY
01
P2000685
OXFORD
NY
Enumeration date
06/10/2006
Last updated
04/07/2022
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