Healthcare Provider Details

I. General information

NPI: 1821510660
Provider Name (Legal Business Name): ANNELISE GABRIELLE BEDERMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2017
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 MADISON AVE STE 15009
NEW YORK NY
10016
US

IV. Provider business mailing address

169 MADISON AVE STE 15009
NEW YORK NY
10016
US

V. Phone/Fax

Practice location:
  • Phone: 646-248-6811
  • Fax:
Mailing address:
  • Phone: 646-248-6811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number327670
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: