Healthcare Provider Details

I. General information

NPI: 1841633476
Provider Name (Legal Business Name): BEDISH BALGOBIN BA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2013
Last Update Date: 04/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9027 SUTPHIN BLVD
JAMAICA NY
11435-3647
US

IV. Provider business mailing address

9027 SUTPHIN BLVD
JAMAICA NY
11435-3647
US

V. Phone/Fax

Practice location:
  • Phone: 718-526-8400
  • Fax: 718-297-8658
Mailing address:
  • Phone: 718-526-8400
  • Fax: 718-297-8658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: