Provider Demographics
NPI:1851558522
Name:PARADISE, MARY BETH (ATC)
Entity Type:Individual
Prefix:
First Name:MARY BETH
Middle Name:
Last Name:PARADISE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 BENDERMERE AVE
Mailing Address - Street 2:
Mailing Address - City:INTERLAKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-4303
Mailing Address - Country:US
Mailing Address - Phone:732-663-1696
Mailing Address - Fax:
Practice Address - Street 1:418 BENDERMERE AVE
Practice Address - Street 2:
Practice Address - City:INTERLAKEN
Practice Address - State:NJ
Practice Address - Zip Code:07712-4303
Practice Address - Country:US
Practice Address - Phone:732-663-1696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT000509002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer