# BETHEL MEDICAL FAMILY PRACTICE,PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1982718607
- **Authorized official:** IMRAN AHMED MD (OWNER)
- **Authorized official phone:** (845) 583-5620

## Contact information

- **Practice address:** 1522 STATE ROUTE 17B, WHITE LAKE, NY 12786-5428
- **Practice address phone:** (845) 583-5620
- **Practice address fax:** (845) 583-8084
- **Mailing address:** 1522 STATE ROUTE 17B, PO BOX 570, WHITE LAKE, NY 12786-5428
- **Mailing address phone:** (845) 583-5620
- **Mailing address fax:** (845) 583-8084

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/18/2006
- **Last updated:** 12/28/2007