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General NPI Number Information
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NPI Number | 1093032302
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Entity Type | Individual
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Provider Name | BIANCA REDHEAD M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/26/2010
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Last Update Date | 10/20/2021
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Provider Practice Location Address
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Address Line | 1 HEALTHY WAY
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City | OCEANSIDE
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State | NY
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Zip | 11572-1551
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Country | US
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Telephone | 516-632-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 4441 PURVES ST APT 2601
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City | LONG ISLAND CITY
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State | NY
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Zip | 11101-2994
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Country | US
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Telephone | 202-415-8724
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 268343
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License Number State | NY
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