| Bethany Clinic Pc | |
|
1010 Main St Ste 208b Paterson NJ 07503-2212 | |
| (973) 320-7120 | |
| Not Available |
| Full Name | Bethany Clinic Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1010 Main St Ste 208b, Paterson, New Jersey |
| Authorized Official Name and Position | Shatha Abudamous (OWNER) |
| Authorized Official Contact | 9735743740 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bethany Clinic Pc 1010 Main St Paterson NJ 07503-2212 Ph: () - | Bethany Clinic Pc 1010 Main St Ste 208b Paterson NJ 07503-2212 Ph: (973) 320-7120 |
| NPI Number | 1811655863 |
|---|---|
| Provider Enumeration Date | 12/06/2021 |
| Last Update Date | 11/26/2023 |
| Medicare PECOS PAC ID | 9638561178 |
|---|---|
| Medicare Enrollment ID | O20220113001549 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811655863 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
| Provider Name | Shatha Abudamous |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1548746225 PECOS PAC ID: 5193117471 Enrollment ID: I20220118002157 |
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