Individual
FAGIE BODNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.T.
Contact information
Practice address
858 E 24TH ST, BROOKLYN, NY 11210-2822
(718) 258-3351
Mailing address
858 E 24TH ST, BROOKLYN, NY 11210-2822
(718) 258-3351
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
010385-1
NY
Other
Enumeration date
05/31/2010
Last updated
05/31/2010
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