MEDICARE: BEDFORD PARK MEDICAL PC

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
1	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00000	OTHER	NY	NYS REGISTRATION

General Provider Information

NPI Number	:	1811483001
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEDFORD PARK MEDICAL PC

Provider Business Mailing Address
First Line	:	9 BAYBERRY RD
Second Line	:
City	:	ELMSFORD
State	:	NY
Zip	:	10523-1701
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1560 GRAND CONCOURSE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10457-8402
Country	:	US
Telephone Number	:	917-792-2087
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CHAULA P PATEL
Credential	:	MD
Telephone Number	:	718-490-1590

Provider Enumeration Date	:	07/10/2018
Last Update Date	:	07/10/2018

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