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NPI Code Detail

MEDICARE: ANDREA BEDOYA PSY.D.

MEDICARE:   ANDREA  BEDOYA  PSY.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist022461NY

General Provider Information

NPI Number : 1811247430
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREA BEDOYA PSY.D.
Provider Business Mailing Address
First Line : 8710 2ND AVE
Second Line :
City : NORTH BERGEN
State : NJ
Zip : 07047-5208
Country : US
Telephone Number : 201-519-2646
Fax Number :
Provider Business Practice Location Address
First Line : 4143 CRESCENT ST
Second Line :
City : LONG ISLAND CITY
State : NY
Zip : 11101-3805
Country : US
Telephone Number : 718-784-2240
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/11/2012
Last Update Date : 12/07/2017

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