Healthcare Provider Details

I. General information

NPI: 1770538191
Provider Name (Legal Business Name): JOEL BEDARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 JERUSALEM AVE
HEMPSTEAD NY
11550
US

IV. Provider business mailing address

275 JERUSALEM AVE
HEMPSTEAD NY
11550
US

V. Phone/Fax

Practice location:
  • Phone: 516-483-3311
  • Fax: 516-483-2805
Mailing address:
  • Phone: 516-483-3311
  • Fax: 516-483-2805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number175353
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: