Healthcare Provider Details

I. General information

NPI: 1114014891
Provider Name (Legal Business Name): MARTINA BEZDICKOVA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 07/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 WEATHERVANE DR
WASHINGTONVILLE NY
10992-2242
US

IV. Provider business mailing address

10 WEATHERVANE DR
WASHINGTONVILLE NY
10992-2242
US

V. Phone/Fax

Practice location:
  • Phone: 845-634-7900
  • Fax: 845-634-0632
Mailing address:
  • Phone: 845-634-7900
  • Fax: 845-634-0632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number222646
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: