Organization
VIVIAN K. BETHALA, MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VIVIAN K BETHALA MD (PRESIDENT)
(201) 261-1005
Entity
Organization
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
25MA0371400
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4906403
—
NJ
Enumeration date
05/10/2006
Last updated
12/02/2016
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