Individual provider Active NPI

Colin A Bethel, MD

  • Pediatric Surgery Physician
  • Maplewood, NJ
National Provider Identifier
1871528943
Registry record updated Dec 21, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Surgery PhysicianTaxonomy code 2086S0120X
License
25MA06559800 Issued in NJ
Practice address
2130 Millburn Avenue
Suite C-1
Maplewood, NJ 07040
Phone
(888) 287-3652
Fax
(973) 549-6079
NPI assigned
Jul 11, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Surgery Physician 2086S0120X 25MA06559800 NJ Primary

Addresses

Primary practice location

2130 Millburn Avenue
Suite C-1
Maplewood, NJ 07040

Mailing address

P.O. Box 785361
Pediatric Surgery Group
Philadelphia, PA 19178
Phone (888) 282-3652

Other identifiers 1

IdentifierTypeStateIssuer
7346409MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080819000134 NJ Practitioner - Pediatric Medicine 0446325948 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Barnabas Health Medical Group PC CurrentSince Dec 29, 2012 Accepting new patients
Barnabas Health Medical Group PC CurrentSince Dec 29, 2012 Accepting new patients
St Josephs Medical Group PC CurrentSince May 10, 2022 Accepting new patients
St. Joseph'S Healthcare, Inc. Past Accepting new patients
Keystone Group, LLC Past Accepting new patients

Locations

475 Route 70
Ste 101
Lakewood, NJ 08701
Phone (732) 364-8000

94 Old Short Hills Rd
Livingston, NJ 07039
Phone (973) 322-5400

201 Lyons Ave
Newark, NJ 07112
Phone (732) 923-7455

201 Lyons Ave
Ste C9
Newark, NJ 07112
Phone (973) 926-7203

11 Getty Ave
Paterson, NJ 07503

703 Main St
Paterson, NJ 07503
Phone (973) 754-2240

703 Main St
#G
Paterson, NJ 07503
Phone (973) 754-6331

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1292889600000",
    "number": "1871528943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 785361",
            "address_2": "PEDIATRIC SURGERY GROUP",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19178",
            "telephone_number": "888-282-3652",
            "fax_number": "973-549-6079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2130 MILLBURN AVENUE",
            "address_2": "SUITE C-1",
            "city": "MAPLEWOOD",
            "state": "NJ",
            "postal_code": "07040",
            "telephone_number": "888-287-3652",
            "fax_number": "973-549-6079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BETHEL",
        "first_name": "COLIN",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-11",
        "last_updated": "2010-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0120X",
            "taxonomy_group": "",
            "desc": "Surgery, Pediatric Surgery",
            "state": "NJ",
            "license": "25MA06559800",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7346409",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Maplewood, NJ

Sources for this page

Verify at the official NPI Registry.