Healthcare Provider Details

I. General information

NPI: 1487089009
Provider Name (Legal Business Name): DEMLER BEDAYO PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2013
Last Update Date: 09/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1070 CLIFTON AVE
CLIFTON NJ
07013-3619
US

IV. Provider business mailing address

1070 CLIFTON AVE
CLIFTON NJ
07013-3619
US

V. Phone/Fax

Practice location:
  • Phone: 973-246-6565
  • Fax: 973-883-0140
Mailing address:
  • Phone: 973-246-6565
  • Fax: 973-883-0140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00825700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: