Provider Demographics
NPI:1447900576
Name:PERRY, BERTHA IRENE (MD)
Entity type:Individual
Prefix:
First Name:BERTHA
Middle Name:IRENE
Last Name:PERRY
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:BERTHA
Other - Middle Name:IRENE
Other - Last Name:ZELAYA RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:340 CHANGEBRIDGE RD APT 353
Mailing Address - Street 2:
Mailing Address - City:PINE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07058-4406
Mailing Address - Country:US
Mailing Address - Phone:716-489-9880
Mailing Address - Fax:
Practice Address - Street 1:11 GETTY AVE
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07053
Practice Address - Country:US
Practice Address - Phone:973-754-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-23
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ25MA1258100208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program