Healthcare Provider Details

I. General information

NPI: 1811655863
Provider Name (Legal Business Name): BETHANY CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2021
Last Update Date: 11/26/2023
Certification Date: 11/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 MAIN ST STE 208B
PATERSON NJ
07503-2212
US

IV. Provider business mailing address

1010 MAIN ST
PATERSON NJ
07503-2212
US

V. Phone/Fax

Practice location:
  • Phone: 973-320-7120
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SHATHA ABUDAMOUS
Title or Position: OWNER
Credential: MD
Phone: 973-574-3740