Provider Demographics
NPI:1043384613
Name:BAILEY, BETH P (DO)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:P
Last Name:BAILEY
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:333 GLEN HEAD RD
Mailing Address - Street 2:SUITE 55
Mailing Address - City:GLEN HEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11545-1947
Mailing Address - Country:US
Mailing Address - Phone:516-671-8101
Mailing Address - Fax:516-671-3237
Practice Address - Street 1:333 GLEN HEAD RD
Practice Address - Street 2:SUITE 55
Practice Address - City:GLEN HEAD
Practice Address - State:NY
Practice Address - Zip Code:11545-1947
Practice Address - Country:US
Practice Address - Phone:516-671-8101
Practice Address - Fax:516-671-3237
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2012-03-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY206641-1208000000X, 2080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02384889Medicaid