Provider Demographics
NPI:1205921145
Name:BARDFELD, LLOYD A
Entity type:Individual
Prefix:
First Name:LLOYD
Middle Name:A
Last Name:BARDFELD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 CORNAGA AVE
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-5002
Mailing Address - Country:US
Mailing Address - Phone:718-337-6345
Mailing Address - Fax:718-337-3229
Practice Address - Street 1:918 CORNAGA AVE
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-5002
Practice Address - Country:US
Practice Address - Phone:718-337-6345
Practice Address - Fax:718-337-3229
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN002317213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY56472AOtherMEDICARE GHI
NY6514ADOtherMEDICARE GHI ST JOHNS
NY00414599Medicaid
NYP25751OtherMEDICARE BLUECROSS/BLUE S
NY00414599Medicaid
NY4561960001Medicare NSC
NY56472AOtherMEDICARE GHI