Provider Demographics
NPI:1710904974
Name:BETHLEHEM PEDIATRICS
Entity Type:Organization
Organization Name:BETHLEHEM PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEYOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-439-7490
Mailing Address - Street 1:785 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054-9713
Mailing Address - Country:US
Mailing Address - Phone:518-439-7490
Mailing Address - Fax:518-439-7491
Practice Address - Street 1:785 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054-9713
Practice Address - Country:US
Practice Address - Phone:518-439-7490
Practice Address - Fax:518-439-7491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty