Healthcare Provider Details

I. General information

NPI: 1891854576
Provider Name (Legal Business Name): KIMBERLY BEDDOWS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 06/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3959 BROADWAY BABIES HOSPITAL ROOM 229
NEW YORK NY
10032
US

IV. Provider business mailing address

3959 BROADWAY BABIES HOSPITAL ROOM 229 NORTH
NEW YORK NY
10032-1559
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-6575
  • Fax: 212-304-7834
Mailing address:
  • Phone: 212-305-6575
  • Fax: 212-305-7834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number381577
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: