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General NPI Number Information
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NPI Number | 1548873334
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Entity Type | Organization
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Legal Business Name | BETHANY MEDICAL CLINIC
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Dates
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Enumeration Date | 08/31/2020
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Last Update Date | 08/31/2020
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Provider Practice Location Address
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Address Line | 222 E 21ST ST STE 1R
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City | NEW YORK
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State | NY
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Zip | 10010-7420
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Country | US
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Telephone | 315-201-0621
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Fax |
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Provider Business Mailing Address
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Address Line | 222 E 31ST ST APT 1R
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City | NEW YORK
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State | NY
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Zip |
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | ASIYE BODUR
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Credential |
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Telephone | 929-300-5070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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