Provider Demographics
NPI:1689794919
Name:BEDERKA, JANE (RNFA)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:BEDERKA
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PLASTIC & RECONSTRUCTIVE SURGERY
Mailing Address - Street 2:400 EAST MAIN STREET
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549
Mailing Address - Country:US
Mailing Address - Phone:914-242-7635
Mailing Address - Fax:
Practice Address - Street 1:PLASTIC ANDRECONSTRUCTIVE SURGERY
Practice Address - Street 2:400 EAST MAIN STREET
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549
Practice Address - Country:US
Practice Address - Phone:914-242-7635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3408211163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical