Provider Demographics
NPI:1417223942
Name:BEZOV, DAVID (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:BEZOV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SERGEY
Other - Middle Name:
Other - Last Name:BEZPROZVANNYY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:409 S 2ND ST STE 2F
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1612
Mailing Address - Country:US
Mailing Address - Phone:717-791-2520
Mailing Address - Fax:717-703-0061
Practice Address - Street 1:65 JAMES STREET
Practice Address - Street 2:THE NEW JERSEY NEUROSCIENCE INSTITUTE
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820
Practice Address - Country:US
Practice Address - Phone:732-632-1685
Practice Address - Fax:732-632-1584
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-29
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD603938872084N0400X
NY2683412084N0400X
NJ25MA089119002084N0600X
PAMD4467132084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103095575Medicaid