Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | 25MA03353800 | NJ |
NPI | 1255871547 |
---|---|
Provider Name | Mr. Vinayak Dattatraya Bodas |
First Address | Newark, NJ 07102 |
Second Address | Newark, NJ 07102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2017 |
Last Update Date | 06/03/2017 |