NPIMap

Organization Active NPI

Vivian K. Bethala, MD PA

  • Specialist
  • Emerson, NJ
National Provider Identifier
1568412799
Registry record updated Dec 2, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
25MA0371400 Issued in NJ
Legal business name
VIVIAN K. BETHALA, MD PA
Practice address
466 Old Hook Rd
Suite 9
Emerson, NJ 07630-1396
Phone
(201) 261-1005
Fax
(201) 261-4208
NPI assigned
May 10, 2006
Last updated
Dec 2, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Vivian K Bethala, MDNPI 1235191800
Title
President
Phone
(201) 261-1005

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X 25MA0371400 NJ Primary

Addresses

Primary practice location

466 Old Hook Rd
Suite 9
Emerson, NJ 07630-1396

Mailing address

466 Old Hook Rd
Suite 9
Emerson, NJ 07630-1396
Phone (201) 261-1005

Other identifiers 1

IdentifierTypeStateIssuer
4906403MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040505000630 NJ Part B Supplier - Clinic/Group Practice 6800884040 Receives reassigned benefits from 2 practitioners
Practice locations: Emerson, NJ

National Provider Directory

National Provider Directory

Locations

466 Old Hook Rd
Ste 9
Emerson, NJ 07630
Phone (201) 261-1005

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 22

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480636800000",
    "number": "1568412799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "466 OLD HOOK RD",
            "address_2": "SUITE 9",
            "city": "EMERSON",
            "state": "NJ",
            "postal_code": "076301396",
            "telephone_number": "201-261-1005",
            "fax_number": "201-261-4208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "466 OLD HOOK RD",
            "address_2": "SUITE 9",
            "city": "EMERSON",
            "state": "NJ",
            "postal_code": "076301396",
            "telephone_number": "201-261-1005",
            "fax_number": "201-261-4208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIVIAN K. BETHALA, MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-10",
        "last_updated": "2016-12-02",
        "status": "A",
        "authorized_official_last_name": "BETHALA",
        "authorized_official_first_name": "VIVIAN",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "201-261-1005",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "NJ",
            "license": "25MA0371400",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4906403",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Emerson, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.