Provider Demographics
NPI:1558502179
Name:BEDEWI, CAROL P (NCTMB)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:P
Last Name:BEDEWI
Suffix:
Gender:F
Credentials:NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-1857
Mailing Address - Country:US
Mailing Address - Phone:973-332-6217
Mailing Address - Fax:
Practice Address - Street 1:164 FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-1857
Practice Address - Country:US
Practice Address - Phone:973-332-6217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-11
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26BT00174500225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist