Individual
DR. VIVIAN K BETHALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
466 OLD HOOK RD, SUITE 9, EMERSON, NJ 07630-1396
(201) 261-1005
(201) 261-4208
Mailing address
466 OLD HOOK RD, SUITE 9, EMERSON, NJ 07630-1396
(201) 261-1005
(201) 261-4208
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
25MA03714400
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4906403
—
NJ
Enumeration date
04/06/2006
Last updated
08/10/2016
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