Provider Demographics
NPI:1912236605
Name:BETHPAGE OB/GYN, P.C.
Entity Type:Organization
Organization Name:BETHPAGE OB/GYN, P.C.
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:THANUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-731-5100
Mailing Address - Street 1:4277 HEMPSTEAD TPKE
Mailing Address - Street 2:STE 102
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-5709
Mailing Address - Country:US
Mailing Address - Phone:516-731-5100
Mailing Address - Fax:516-731-3758
Practice Address - Street 1:4277 HEMPSTEAD TPKE
Practice Address - Street 2:STE 102
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-5709
Practice Address - Country:US
Practice Address - Phone:516-731-5100
Practice Address - Fax:516-731-3758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty