Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 222646 | NY |
NPI | 1114014891 |
---|---|
Provider Name | Dr. Martina Bezdickova |
First Address | Washingtonville, NY 10992-2242 |
Second Address | Washingtonville, NY 10992-2242 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2006 |
Last Update Date | 22/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02659805 | (05) | NY |