Healthcare Provider Details

I. General information

NPI: 1619145141
Provider Name (Legal Business Name): BETHLEHEM ENDOSCOPY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2008
Last Update Date: 02/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5325 NORTHGATE DR SUITE 101
BETHLEHEM PA
18017-9411
US

IV. Provider business mailing address

5325 NORTHGATE DR SUITE 101
BETHLEHEM PA
18017-9411
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 Number15601501
License Number StatePA

VIII. Authorized Official

Name: DR. W TERENCE REILLY
Title or Position: GENERAL PARTNER
Credential: MD
Phone: 610-866-5008