Healthcare Provider Details

I. General information

NPI: 1447362769
Provider Name (Legal Business Name): BETHLEHEM ENDOSCOPY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5325 NORTH GATE DRIVE SUITE 101
BETHLEHEM PA
18017
US

IV. Provider business mailing address

5325 NORTH GATE DRIVE SUITE 101
BETHLEHEM PA
18017
US

V. Phone/Fax

Practice location:
  • Phone: 610-866-5008
  • Fax: 610-866-6008
Mailing address:
  • Phone: 610-866-5008
  • Fax: 610-866-6008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number15601501
License Number StatePA

VIII. Authorized Official

Name: JONATHAN BAILEY
Title or Position: OFFICER/AO
Credential:
Phone: 203-609-1168