Provider Demographics
NPI:1316219256
Name:BETHEL MEDICAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:BETHEL MEDICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-499-2460
Mailing Address - Street 1:10 ESQUIRE RD STE 9
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-3336
Mailing Address - Country:US
Mailing Address - Phone:845-499-2460
Mailing Address - Fax:
Practice Address - Street 1:10 ESQUIRE RD
Practice Address - Street 2:SUITE 9
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-3336
Practice Address - Country:US
Practice Address - Phone:845-499-2460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-08
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225651207R00000X
NY259643207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty