Healthcare Provider Details

I. General information

NPI: 1275768343
Provider Name (Legal Business Name): BEHZAD BEN BIDADI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2009
Last Update Date: 07/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 BRADHURST AVE SUITE 1400
HAWTHORNE NY
10532-2140
US

IV. Provider business mailing address

PO BOX 1020
HAWTHORNE NY
10532-7507
US

V. Phone/Fax

Practice location:
  • Phone: 914-594-2222
  • Fax: 914-594-2221
Mailing address:
  • Phone: 888-633-0033
  • Fax: 914-593-1802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number106354
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number55559
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number279946
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: