Provider Demographics
NPI:1497126056
Name:BETHEL INTERVENTIONAL PAIN MANAGEMENT, LLC
Entity Type:Organization
Organization Name:BETHEL INTERVENTIONAL PAIN MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-261-0720
Mailing Address - Street 1:385 SYLVAN AVE
Mailing Address - Street 2:SUITE 23
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632-2726
Mailing Address - Country:US
Mailing Address - Phone:201-568-3600
Mailing Address - Fax:201-567-7900
Practice Address - Street 1:385 SYLVAN AVE
Practice Address - Street 2:SUITE 23
Practice Address - City:ENGLEWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632-2726
Practice Address - Country:US
Practice Address - Phone:201-568-3600
Practice Address - Fax:201-567-7900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-08
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08408300305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service