Beth Abbott Pelletier, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

RT004941 Issued in PA

Practice address

605 Main St
Hackensack, NJ 07601-5914

Phone

(201) 488-0488

NPI assigned

Jun 16, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Ms. Beth Anne Abbott Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1560643200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560643200000",
    "number": "1124688809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 BOWERS ST FL 1",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "073072007",
            "telephone_number": "609-425-3200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 MAIN ST",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076015914",
            "telephone_number": "201-488-0488"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "103 Bowers St Fl 1",
            "address_purpose": "LOCATION",
            "city": "Jersey City",
            "state": "NJ",
            "postal_code": "073072007",
            "country_code": "US",
            "telephone_number": "609-425-3200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PELLETIER",
        "first_name": "BETH",
        "middle_name": "ABBOTT",
        "name_prefix": "Mrs.",
        "credential": "ATC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-06-16",
        "last_updated": "2019-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "PA",
            "license": "RT004941",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BETH",
            "last_name": "ABBOTT",
            "middle_name": "ANNE",
            "prefix": "MS.",
            "credential": "ATC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Athletic Trainer in Hackensack, NJ
• Providers in Hackensack, NJ by specialty
• Athletic Trainer in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.