Provider Demographics
NPI:1245418409
Name:PEROSI, BETH
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:PEROSI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 FOX MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-2707
Mailing Address - Country:US
Mailing Address - Phone:732-796-0033
Mailing Address - Fax:
Practice Address - Street 1:2101 HIGHWAY 35
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1085
Practice Address - Country:US
Practice Address - Phone:732-671-3362
Practice Address - Fax:732-671-5435
Is Sole Proprietor?:No
Enumeration Date:2008-02-09
Last Update Date:2008-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25432183500000X
NY034065-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY034065-1OtherRPH LICENSE #
NJ25432OtherRPH LICENSE #