Provider Demographics
NPI:1487626289
Name:BEBIRIAN, RICHARD JOHN (DO)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:JOHN
Last Name:BEBIRIAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CARMAN GATE
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758
Mailing Address - Country:US
Mailing Address - Phone:516-795-4343
Mailing Address - Fax:516-795-4115
Practice Address - Street 1:1 CARMAN GATE
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758
Practice Address - Country:US
Practice Address - Phone:516-795-4343
Practice Address - Fax:516-795-4115
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY163415207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY12721OtherVYTRA
NY01252359Medicaid
NYAP211OtherOXFORD
NY01252359Medicaid
NY12721OtherVYTRA