Provider Demographics
NPI:1811429327
Name:BETHPAGE MEDICAL PLLC
Entity type:Organization
Organization Name:BETHPAGE MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIAL COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BRIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:FARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-414-5865
Mailing Address - Street 1:P.O BOX 310
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803
Mailing Address - Country:US
Mailing Address - Phone:516-414-5865
Mailing Address - Fax:
Practice Address - Street 1:4150 SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-5303
Practice Address - Country:US
Practice Address - Phone:516-414-6900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty