Provider Demographics
NPI:1326211822
Name:BEZKOR, EDWARD WILLIAM (DPT, OCS, MTC)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:WILLIAM
Last Name:BEZKOR
Suffix:
Gender:M
Credentials:DPT, OCS, MTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-2418
Mailing Address - Country:US
Mailing Address - Phone:917-698-3578
Mailing Address - Fax:
Practice Address - Street 1:9350 CAMPUS POINT DR # LL-D
Practice Address - Street 2:SUITE 1
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1300
Practice Address - Country:US
Practice Address - Phone:858-657-6879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-07
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0185021225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist