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NPI Code Detail

MEDICARE: DR. BETHEL TADESSE MANDEFRO

MEDICARE: DR. BETHEL TADESSE MANDEFRO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training ProgramNY

General Provider Information

NPI Number : 1295671659
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BETHEL TADESSE MANDEFRO
Provider Business Mailing Address
First Line : 4422 3RD AVE # 10457
Second Line :
City : BRONX
State : NY
Zip : 10457-2545
Country : US
Telephone Number : 718-960-6202
Fax Number :
Provider Business Practice Location Address
First Line : 4422 3RD AVE # 10457
Second Line :
City : BRONX
State : NY
Zip : 10457-2545
Country : US
Telephone Number : 718-960-6202
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/28/2026
Last Update Date : 05/25/2026

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Directions to “ DR. BETHEL TADESSE MANDEFRO ” Practice Location

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