Provider Demographics
NPI:1124688809
Name:PELLETIER, BETH ABBOTT (ATC)
Entity type:Individual
Prefix:MRS
First Name:BETH
Middle Name:ABBOTT
Last Name:PELLETIER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:MS
Other - First Name:BETH
Other - Middle Name:ANNE
Other - Last Name:ABBOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:103 BOWERS ST FL 1
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07307-2007
Mailing Address - Country:US
Mailing Address - Phone:609-425-3200
Mailing Address - Fax:
Practice Address - Street 1:605 MAIN ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-5914
Practice Address - Country:US
Practice Address - Phone:201-488-0488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-16
Last Update Date:2019-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0049412255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer