Doctor Name: | BETHANY BROOKE PAJAK |
NPI Number: | 1194011122 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | D.O. |
License Number: | 070562 |
Business Practice Address: | 1001 West St Carthage, NY - 136199703 |
Business Phone Number: | 3154931000 |
Business Fax Number: | |
Mailing Address: | 1001 West St, CARTHAGE |
State: | NY |
Postal Code: | 136199703 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 06/28/2011 |
NPI Last Update Date: | 11/19/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 070562 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | GA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |