Healthcare Provider Details

I. General information

NPI: 1093032302
Provider Name (Legal Business Name): BIANCA REDHEAD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2010
Last Update Date: 10/20/2021
Certification Date: 10/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HEALTHY WAY
OCEANSIDE NY
11572-1551
US

IV. Provider business mailing address

4441 PURVES ST APT 2601
LONG ISLAND CITY NY
11101-2994
US

V. Phone/Fax

Practice location:
  • Phone: 516-632-3000
  • Fax:
Mailing address:
  • Phone: 202-415-8724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number268343
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: