Provider Demographics
NPI:1740396159
Name:BEYDA, BERNADETTE (MD)
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:
Last Name:BEYDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14123 59TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355
Mailing Address - Country:US
Mailing Address - Phone:718-445-0566
Mailing Address - Fax:718-359-2592
Practice Address - Street 1:14123 59TH AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355
Practice Address - Country:US
Practice Address - Phone:718-445-0566
Practice Address - Fax:718-359-2592
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2010-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY139854207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00724832Medicaid
NY00724832Medicaid
E39140Medicare UPIN