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NPI Code Detail

MEDICARE: BETH ELLEN ZEDECK CPNP

MEDICARE: BETH ELLEN ZEDECK CPNP
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
1363LP0200XPediatric Nurse Practitioner381796NY

General Provider Information

NPI Number : 1821210782
Entity Type Code : Individual
Provider Name (Legal Business Name) : BETH ELLEN ZEDECK CPNP
Provider Business Mailing Address
First Line : 200 HAVEN AVE APT 3N
Second Line :
City : NEW YORK
State : NY
Zip : 10033-5306
Country : US
Telephone Number : 631-682-1308
Fax Number :
Provider Business Practice Location Address
First Line : 219 E 121ST ST
Second Line :
City : NEW YORK
State : NY
Zip : 10035-3018
Country : US
Telephone Number : 212-987-5135
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/02/2007
Last Update Date : 07/08/2007

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