Provider Demographics
NPI:1700911377
Name:BETH ABRAHAM HEALTH SERVICES
Entity Type:Organization
Organization Name:BETH ABRAHAM HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:VALLEJO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-515-8600
Mailing Address - Street 1:2401 WHITE PLAINS RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-8108
Mailing Address - Country:US
Mailing Address - Phone:718-515-8600
Mailing Address - Fax:718-653-2078
Practice Address - Street 1:2401 WHITE PLAINS RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-8108
Practice Address - Country:US
Practice Address - Phone:718-515-8600
Practice Address - Fax:718-653-2078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY189917302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY189917OtherNY LICENSE
NYF53053Medicare UPIN