Provider Demographics
NPI:1245373117
Name:BODDIE, ALBERT FRANCIS (LPN)
Entity type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:FRANCIS
Last Name:BODDIE
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 LENT AVE
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:NY
Mailing Address - Zip Code:10548-1109
Mailing Address - Country:US
Mailing Address - Phone:914-736-3258
Mailing Address - Fax:
Practice Address - Street 1:28 LENT AVE
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:NY
Practice Address - Zip Code:10548-1109
Practice Address - Country:US
Practice Address - Phone:914-736-3258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY150757146N00000X
NY195699164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
Not Answered164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02559442Medicaid