Healthcare Provider Details

I. General information

NPI: 1689641722
Provider Name (Legal Business Name): INGRID BEDINOTTI PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 09/03/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 NEW SCOTLAND AVE
ALBANY NY
12208-3412
US

IV. Provider business mailing address

47 NEW SCOTLAND AVE
ALBANY NY
12208-3412
US

V. Phone/Fax

Practice location:
  • Phone: 518-262-5831
  • Fax: 518-262-6358
Mailing address:
  • Phone: 518-262-5831
  • Fax: 518-262-6358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number009909
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: