Healthcare Provider Details

I. General information

NPI: 1356703797
Provider Name (Legal Business Name): BATHORY INTERNATIONAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2016
Last Update Date: 03/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2575 WOODBERRY DR
WINSTON SALEM NC
27106-4622
US

IV. Provider business mailing address

2575 WOODBERRY DR
WINSTON SALEM NC
27106-4622
US

V. Phone/Fax

Practice location:
  • Phone: 908-444-1524
  • Fax:
Mailing address:
  • Phone: 908-444-1524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number2311
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2311
License Number StateNC

VIII. Authorized Official

Name: DAVID BATHORY
Title or Position: CEO
Credential: PSYD
Phone: 908-444-1524