Provider Demographics
NPI:1114014891
Name:BEZDICKOVA, MARTINA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTINA
Middle Name:
Last Name:BEZDICKOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WEATHERVANE DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10992-2242
Mailing Address - Country:US
Mailing Address - Phone:845-634-7900
Mailing Address - Fax:845-634-0632
Practice Address - Street 1:10 WEATHERVANE DR
Practice Address - Street 2:
Practice Address - City:WASHINGTONVILLE
Practice Address - State:NY
Practice Address - Zip Code:10992-2242
Practice Address - Country:US
Practice Address - Phone:845-634-7900
Practice Address - Fax:845-634-0632
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2226462080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02659805Medicaid