Provider Demographics
NPI:1295928489
Name:BEDFORD MEDICAL FAMILY HEALTH CENTER
Entity type:Organization
Organization Name:BEDFORD MEDICAL FAMILY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ARIELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:RITVO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-387-7628
Mailing Address - Street 1:100 ROSS ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11249-7672
Mailing Address - Country:US
Mailing Address - Phone:718-387-7628
Mailing Address - Fax:
Practice Address - Street 1:100 ROSS ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11249-7672
Practice Address - Country:US
Practice Address - Phone:718-387-7628
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00802699Medicaid