Organization
BETHPAGE MEDICAL WELLNESS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BITA ASHOURZADEH MD (OWNER)
(516) 610-5081
Entity
Organization
Contact information
Practice address
4250 HEMPSTEAD TPKE, SUITE 19, BETHPAGE, NY 11714-5711
(516) 597-4433
Mailing address
4250 HEMSTEAD TURNPIKE, SUITE 19, BETHPAGE, NY 11714-5707
(516) 597-4433
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
221358
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02227989
—
NY
Enumeration date
09/14/2012
Last updated
06/27/2024
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