Healthcare Provider Details

I. General information

NPI: 1912275827
Provider Name (Legal Business Name): HERIBERTO BEDOYA RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2011
Last Update Date: 12/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 60TH ST
WEST NEW YORK NJ
07093-5412
US

IV. Provider business mailing address

335 60TH ST
WEST NEW YORK NJ
07093-5412
US

V. Phone/Fax

Practice location:
  • Phone: 201-854-1829
  • Fax: 201-854-6371
Mailing address:
  • Phone: 201-854-1829
  • Fax: 201-854-6371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI02820700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: