Healthcare Provider Details

I. General information

NPI: 1689794919
Provider Name (Legal Business Name): JANE BEDERKA R.N.F.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PLASTIC ANDRECONSTRUCTIVE SURGERY 400 EAST MAIN STREET
MOUNT KISCO NY
10549
US

IV. Provider business mailing address

PLASTIC & RECONSTRUCTIVE SURGERY 400 EAST MAIN STREET
MOUNT KISCO NY
10549
US

V. Phone/Fax

Practice location:
  • Phone: 914-242-7635
  • Fax:
Mailing address:
  • Phone: 914-242-7635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number3408211
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: