Healthcare Provider Details

I. General information

NPI: 1710904974
Provider Name (Legal Business Name): BETHLEHEM PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

785 DELAWARE AVE
DELMAR NY
12054-9713
US

IV. Provider business mailing address

785 DELAWARE AVE
DELMAR NY
12054-9713
US

V. Phone/Fax

Practice location:
  • Phone: 518-439-7490
  • Fax: 518-439-7491
Mailing address:
  • Phone: 518-439-7490
  • Fax: 518-439-7491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. THERESA DEYOE
Title or Position: OFFICE MGR
Credential:
Phone: 518-439-7490