Provider Demographics
NPI:1598171092
Name:BEDFORD REGIONAL UROLOGY
Entity Type:Organization
Organization Name:BEDFORD REGIONAL UROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.O
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:YANOSHAK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:814-623-0552
Mailing Address - Street 1:202 MEMORIAL DR STE 2
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:PA
Mailing Address - Zip Code:15537-7057
Mailing Address - Country:US
Mailing Address - Phone:814-623-0552
Mailing Address - Fax:814-623-0752
Practice Address - Street 1:202 MEMORIAL DR STE 2
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:PA
Practice Address - Zip Code:15537-7057
Practice Address - Country:US
Practice Address - Phone:814-623-0552
Practice Address - Fax:814-623-0752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-03
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA05007645L261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center