Basic Information
| Provider Information | |||||||||
| NPI: | 1538166095 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BIDOT | ||||||||
| FirstName: | RAMON | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5010 ST. HWY 30 | ||||||||
| Address2: | SUITE G-02 | ||||||||
| City: | AMSTERDAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5188420017 | ||||||||
| FaxNumber: | 5188427545 | ||||||||
| Practice Location | |||||||||
| Address1: | 5010 STATE HIGHWAY 30 | ||||||||
| Address2: | SUITE G-02 | ||||||||
| City: | AMSTERDAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 120107532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5188420017 | ||||||||
| FaxNumber: | 5188420017 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2005 | ||||||||
| LastUpdateDate: | 08/19/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 206689-1 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | 206689-1 | NY | N | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 01752125 | 05 | NY | MEDICAID |