Provider Demographics
NPI:1902891716
Name:BEDER, JOAN C (JOAN BEDER)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:C
Last Name:BEDER
Suffix:
Gender:F
Credentials:JOAN BEDER
Other - Prefix:DR
Other - First Name:JOAN
Other - Middle Name:
Other - Last Name:BEDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:JOAN BEDER
Mailing Address - Street 1:30 HICKS LN
Mailing Address - Street 2:
Mailing Address - City:OLD WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11568-1618
Mailing Address - Country:US
Mailing Address - Phone:516-997-8326
Mailing Address - Fax:
Practice Address - Street 1:30 HICKS LN
Practice Address - Street 2:
Practice Address - City:OLD WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11568-1618
Practice Address - Country:US
Practice Address - Phone:516-997-8326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0258251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN30261Medicare ID - Type Unspecified