Healthcare Provider Details

I. General information

NPI: 1518919968
Provider Name (Legal Business Name): BEDFORD ANESTHESIA, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 05/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 SOUTH BEDFORD ROAD
MT KISCO NY
10549
US

IV. Provider business mailing address

110 SOUTH BEDFORD ROAD
MT KISCO NY
10549
US

V. Phone/Fax

Practice location:
  • Phone: 914-244-6789
  • Fax: 914-242-1516
Mailing address:
  • Phone: 914-244-6789
  • Fax: 914-242-1516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: SCOTT D HAYWORTH
Title or Position: CEO
Credential: MD
Phone: 914-244-6789