Provider Demographics
NPI:1144464942
Name:BODKIN, JOHN JOSEPH III (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JOSEPH
Last Name:BODKIN
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:3085 HARLEM RD STE 350
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-2591
Mailing Address - Country:US
Mailing Address - Phone:716-844-5000
Mailing Address - Fax:716-844-5050
Practice Address - Street 1:3085 HARLEM RD STE 200
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-2591
Practice Address - Country:US
Practice Address - Phone:716-844-5000
Practice Address - Fax:716-844-5050
Is Sole Proprietor?:No
Enumeration Date:2009-04-23
Last Update Date:2022-07-21
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Provider Licenses
StateLicense IDTaxonomies
NY263225208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04770825Medicaid