Basic Information
Provider Information
NPI: 1902119381
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BREDEFELD
FirstName: CINDY
MiddleName: LEE
NamePrefix: DR.
NameSuffix:  
Credential: D.O
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1300 FRANKLIN AVE
Address2: SUITE ML-6
City: GARDEN CITY
State: NY
PostalCode: 115301886
CountryCode: US
TelephoneNumber: 5166633511
FaxNumber: 5166634780
Practice Location
Address1: 1300 FRANKLIN AVE
Address2: SUITE ML-6
City: GARDEN CITY
State: NY
PostalCode: 115301886
CountryCode: US
TelephoneNumber: 5166633511
FaxNumber: 5166634780
Other Information
ProviderEnumerationDate: 07/14/2010
LastUpdateDate: 02/26/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/26/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RE0101X257899NYY Allopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism

No ID Information.


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