Active NPI
Deborah Berger, PTA, CLT
- Physical Therapy Assistant
- West Long Branch, NJ
National Provider Identifier
1619254216
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 40QB00282500
- Practice address
- 240 Wall St
Suite 100
West Long Branch, NJ 07764-1181 - Phone
- (732) 222-8556
- Fax
- (732) 222-8663
- NPI assigned
- Nov 10, 2011
- Last updated
- Nov 10, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 40QB00282500 | NJ | Primary |
Addresses
Primary practice location
240 Wall St
Suite 100
West Long Branch, NJ 07764-1181
Mailing address
123 C St
Brick, NJ 08723-7252
Phone (732) 255-0049
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 40QB00282500 | NJ | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wyatt Medical, LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1320883200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1320883200000",
"number": "1619254216",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "123 C ST",
"city": "BRICK",
"state": "NJ",
"postal_code": "087237252",
"telephone_number": "732-255-0049"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "240 WALL ST",
"address_2": "SUITE 100",
"city": "WEST LONG BRANCH",
"state": "NJ",
"postal_code": "077641181",
"telephone_number": "732-222-8556",
"fax_number": "732-222-8663"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERGER",
"first_name": "DEBORAH",
"credential": "PTA, CLT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-11-10",
"last_updated": "2011-11-10",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "NJ",
"license": "40QB00282500",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Long Branch, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.