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General NPI Number Information
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NPI Number | 1346715877
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Entity Type | Organization
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Legal Business Name | BEDFORD RECONSTRUCTIVE SURGERY PC
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Dates
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Enumeration Date | 10/11/2018
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Last Update Date | 10/11/2018
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Provider Practice Location Address
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Address Line | 417 VIA ANITA
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City | REDONDO BEACH
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State | CA
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Zip | 90277-6623
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Country | US
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Telephone | 516-439-5160
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Fax | 516-439-5161
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Provider Business Mailing Address
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Address Line | 2631 MERRICK RD STE 200
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City | BELLMORE
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State | NY
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Zip | 11710-5784
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Country | US
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Telephone | 516-439-5160
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Fax | 516-439-5161
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | DR. TZE YUNG IP
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Credential | MD
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Telephone | 516-439-5160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State |
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