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General NPI Number Information
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NPI Number | 1710904974
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Entity Type | Organization
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Legal Business Name | BETHLEHEM PEDIATRICS
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Dates
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Enumeration Date | 07/16/2006
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Last Update Date | 06/20/2008
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Provider Practice Location Address
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Address Line | 785 DELAWARE AVE
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City | DELMAR
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State | NY
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Zip | 12054-9713
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Country | US
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Telephone | 518-439-7490
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Fax | 518-439-7491
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Provider Business Mailing Address
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Address Line | 785 DELAWARE AVE
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City | DELMAR
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State | NY
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Zip | 12054-9713
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Country | US
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Telephone | 518-439-7490
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Fax | 518-439-7491
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Authorized Official
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Title or Position | OFFICE MGR
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Name | MRS. THERESA DEYOE
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Credential |
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Telephone | 518-439-7490
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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